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Prediction of prognosis in chronic obstructive pulmonary disease patients with respiratory failure: A comparison of three nutritional assessment methods

  • Author Footnotes
    1 These authors contributed equally to this work.
    Ruiqi Chen
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    West China School of medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Lu Xing
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
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  • Chao You
    Affiliations
    West China School of medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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  • Xuemei Ou
    Correspondence
    Corresponding author at: No.37 Guo Xue Xiang, Chengdu, Sichuan Province 610041, China.
    Affiliations
    Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.

      Highlights

      • A total of 438 COPD patients with respiratory failure in 3 years of interval.
      • The best nutritional assessment method varies in prediction of different prognosis.
      • ALB level is superior to predict the short term prognosis.
      • NRS 2002 is better for the prediction of long-term clinical outcome.

      Abstract

      Objectives

      Due to their increased energy expenditure, chronic obstructive pulmonary disease (COPD) patients with respiratory failure are susceptible to malnutrition. This study aimed to compare the predictive values of the following three widely used nutritional assessment methods for the clinical prognosis of COPD patients with respiratory failure: body mass index (BMI), Nutritional Risk Screening 2002 (NRS 2002), and serum albumin (ALB) level.

      Methods

      COPD patients with respiratory failure treated in our center from June 2013 to June 2016 were retrospectively included. Patient BMI, NRS 2002 and ALB values were measured to assess their nutritional status. A multivariable analysis was conducted, and receiver operating characteristic (ROC) curves were generated to explore the predictive factors for clinical prognoses.

      Results

      A total of 438 qualified patients were enrolled in our study. Multivariable analysis revealed that the BMI and ALB values independently predicted in-hospital mortality, the BMI and NRS 2002 predicted 1-year mortality, and all three methods (BMI, NRS 2002, and ALB) predicted 30-day readmission after discharge (P < 0.05). Regarding the results of the AUROC analysis, the optimal cutoff values that maximized the ability to predict the prognosis were an ALB level of 30.5 g/L for in-hospital mortality, an NRS 2002 score of 3 points for 1-year mortality, and an ALB level of 30.1 g/L for readmission within 30 days following discharge.

      Conclusions

      For COPD patients with respiratory failure, ALB level was superior for predicting in-hospital mortality and 30-day readmission after discharge, and NRS 2002 was superior for long-term prognosis of 1-year mortality.

      Keywords

      Abbreviation list:

      ALB (Serum albumin), AUROC (Area under the ROC curve), BMI (Body mass index), CI (Confidence intervals), COPD (Chronic obstructive pulmonary disease), HIS (Hospital information system), IRB (Institutional review board), LR (Likelihood ratio), NRS 2002 (Nutritional Risk Screening 2002), OR (Odds ratio), ROC (Receiver operating characteristic), SD (Standard deviation), WCH (West China Hospital)
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