Journal Article

It’s more than low BMI: prevalence of cachexia and associated mortality in COPD

Wouters, Emiel F. M., Celli, Bartolome, Dransfield, Mark, Silverman, Edwin K., Lomas, David A., Tal-Singer, Ruth, Rennard, Stephen I., Bamman, Marcas, Hersh, Craig P., McDonald, Merry-Lynn N., Casaburi, Richard, Rutten, Erica, Agusti, Alvar

2019

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Nature Publishing Group,BMC
• Subject: Age / Aged / Anemia / Anorexia / Biochemistry / BMI / BODE / Body Mass Index / Body size / Body weight / Body weight loss / C-reactive protein / Cachexia / Cachexia - diagnosis / Cachexia - mortality / Cancer / Chi-square test / Chronic illnesses / Chronic obstructive lung disease / Chronic obstructive pulmonary disease / Complications and side effects / Consensus / COPD / Disease / Dyspnea / Eating disorders / Fatigue / Female / Health aspects / Health risks / Hemoglobin / Humans / Inflammation / Lung diseases / Male / Medicine / Medicine & Public Health / Middle Aged / Mortality / Mortality - trends / Mortality risk / Muscle strength / Muscular fatigue / Obstructive lung disease / Overweight / Patient monitoring equipment / Patient outcomes / Pneumology/Respiratory System / Prevalence / Pulmonary Disease, Chronic Obstructive - diagnosis / Pulmonary Disease, Chronic Obstructive - mortality / Regression analysis / Respiration / Respiratory function / Sarcopenia / Spirometry / Statistical analysis / Weight loss / Weight Loss - physiology