Document Type
Article
Journal Title
Respiratory Research
Publication Date
2019
Volume
20
Abstract
BACKGROUND: Cachexia is associated with increased mortality risk among chronic obstructive pulmonary disease (COPD) patients. However, low body mass index (BMI) as opposed to cachexia is often used, particularly when calculating the BODE (BMI, Obstruction, Dyspnea and Exercise) index. For this reason, we examined mortality using a consensus definition and a weight-loss definition of cachexia among COPD cases and compared two new COPD severity indices with BODE.
METHODS: In the current report, the consensus definition for cachexia incorporated weight-loss > 5% in 12-months or low BMI in addition to 3/5 of decreased muscle strength, fatigue, anorexia, low FFMI and inflammation. The weight-loss definition incorporated weight-loss > 5% or weight-loss > 2% (if low BMI) in 12-months. The low BMI component in BODE was replaced with the consensus definition to create the CODE (Consensus cachexia, Obstruction, Dyspnea and Exercise) index and the weight-loss definition to create the WODE (Weight loss, Obstruction, Dyspnea and Exercise) index. Mortality was assessed using Kaplan-Meier survival and Cox Regression. Performance of models was compared using C-statistics.
RESULTS: Among 1483 COPD cases, the prevalences of cachexia by the consensus and weight-loss definitions were 4.7 and 10.4%, respectively. Cachectic patients had a greater than three-fold increased mortality by either the consensus or the weight-loss definition of cachexia independent of BMI and lung function. The CODE index predicted mortality slightly more accurately than the BODE and WODE indices.
CONCLUSIONS: Cachexia is associated with increased mortality among COPD patients. Monitoring cachexia using weight-loss criteria is relatively simple and predictive of mortality among COPD cases who may be missed if only low BMI is used.
MeSH Headings
Aged, Body Mass Index, Cachexia, Consensus, Female, Humans, Male, Middle Aged, Mortality, Prevalence, Pulmonary Disease, Chronic Obstructive, Weight Loss
DOI Link
ISSN
1465-993X
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
McDonald, Merry-Lynn N.; Wouters, Emiel F.M.; Rutten, Erica; Casaburi, Richard; Rennard, Stephen I.; Lomas, David A.; Bamman, Marcas; Celli, Bartolome; Agusti, Alvar; Tal-Singer, Ruth; Hersh, Craig P.; Dransfield, Mark; and Silverman, Edwin K., "It's More Than Low BMI: Prevalence of Cachexia and Associated Mortality in COPD" (2019). Journal Articles: Pulmonary & Critical Care Med. 34.
https://digitalcommons.unmc.edu/com_pulm_articles/34
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