Malnutrition Linked to Readmission in Older COPD Patients

Malnutrition, very severe airway obstruction, and the presence of three or more comorbidities were significant predictors of 180-day readmission for older adults with chronic obstructive pulmonary disease (COPD), based on data from more than 300 individuals.

Malnutrition is common in older patients with COPD, who also experience high rates of hospital readmission, but the association between nutrition status and readmission has not been examined, wrote Huan Liu, PhD, of Sichuan University, Chengdu, China, and colleagues.

“Researchers in related fields are increasingly focusing on the comorbidities of COPD; however, nutrition-related comorbidities, especially malnutrition, are often overlooked,” the investigators wrote.

In a study published in Aging Clinical and Experimental Research, the investigators reviewed data from 319 adults aged 65 years or older who were hospitalized for the first time with COPD at a single center in Southwest China. The primary outcome was hospital readmission within 180 days.

The median age of the study population was 76 years, and 65.52% were men. The baseline median length of hospital stay was 12 days, and the patients had a median of five comorbidities. Based on the Global Leadership Initiative on Malnutrition criteria, 49.53% of the patients were considered malnourished.

Overall, the 180-day readmission rate was significantly higher in patients with malnutrition vs those without malnutrition (30.38% vs 10.56%, P < .001).

In a multivariate analysis, malnutrition was associated with a significantly increased risk for hospital readmission (odds ratio [OR], 3.184), as was very severe airway obstruction (OR, 3.735) and three or more comorbidities (OR, 5.754).

“Malnutrition is identified as one of the modifiable factors in several high-quality studies related to readmission,” the researchers wrote in their discussion. “Nutritional intervention can increase lean body mass in malnourished COPD patients, enhance their respiratory muscle function, and improve their overall health status. Therefore, active nutritional interventions should be implemented for patients with malnutrition,” they said.

The researchers also noted the association between very severe airway obstruction and hospital readmission, whereas moderate and severe airway obstruction had no apparent impact. Consequently, they advised greater attention to pulmonary rehabilitation education and pulmonary function exercises, as well as the use of medications to improve or maintain pulmonary function in these very severe cases to help reduce the risk for hospital readmission.

The findings were limited by several factors, including the cross-sectional design and inability to prove causal relationships, the potential lack of generalizability to older patients with COPD in the community or in rehab hospitals, and the use of grip strength as an assessment of muscle mass reduction (malnutrition), the researchers noted. However, the results indicate that malnutrition is a risk factor for 180-day readmission in older adults with COPD. Looking ahead, the findings highlight the need to monitor the nutritional status of older adults with COPD and to intervene early for those with malnutrition to improve outcomes, they concluded.

Step Up Early Intervention for Nutrition in Older Patients With COPD

Malnutrition is known to be a major issue and risk factor for worse outcomes in hospitalized patients, said David R. Manoff, MD, in an interview. “Similarly, we have known for years that patients with COPD who lose weight or cannot gain weight do worse,” said Manoff, Chief of Pulmonary & Critical Care Medicine at Temple University Hospital, Jeanes Campus, Philadelphia.

The current study shows that the risk for worse outcomes holds true even for the specific group of patients with COPD who are hospitalized, and these results were not unexpected, Manoff said. “As we focus on readmission reduction measures, this is a specific group to highlight,” he added.

The takeaway messages from the study are twofold, Manoff told Medscape Medical News. “The first is that early intervention on nutrition for patients with COPD may help to avoid these worsened outcomes,” he said. The second message is that as clinicians are targeting specific subgroups for more aggressive measures to treat severe exacerbations and reduce readmissions, older adults with COPD “are easily identified and would be a good group on which to focus,” he noted.

The main limitations of the current study are the retrospective design and focus on a Chinese population; therefore, a prospective trial involving a large cohort with COPD and malnutrition would be the appropriate next step for research, Manoff added.

The study was supported by the Science & Technology Department of Sichuan Province. The researchers had no financial conflicts to disclose. Manoff had no financial conflicts to disclose.