Malnutrition in Older Patients With COPD Linked to Higher Hospital Readmission Rates

Malnutrition is prevalent among older hospitalized patients with chronic obstructive pulmonary disease (COPD), contributing to their 180-day hospital readmission rate, according to a study published in Aging Clinical and Experimental Research.¹

Although researchers are increasingly focusing on COPD comorbidities, nutrition-related comorbidities, especially malnutrition, are often overlooked.² The researchers explained that malnutrition is closely associated with poor clinical outcomes, significantly burdening health care resources.³ Depending on the population and diagnostic methods, between 20% and 45% of hospitalized patients with COPD suffer from malnutrition.⁴

However, there are currently few studies using the Global Leadership Initiative on Malnutrition (GLIM) criteria to evaluate the nutrition status of older hospitalized patients with COPD, as most research focuses on those in communities or rehabilitation centers¹; the GLIM criteria were published to establish a global consensus on the clinical diagnosis of malnutrition.⁵

Consequently, it remains unclear whether nutrition status affects the hospital readmission rate of patients with COPD.¹ Therefore, using the GLIM criteria, the researchers conducted a study to evaluate the nutrition status of older hospitalized patients with COPD, determine the incidence of malnutrition, and explore the factors that affect the readmission rate.

Malnutrition significantly increases the 180-day hospital readmission rates among patients 65 years or older who have chronic obstructive pulmonary disease. | Image Credit: Feng Yu - stock.adobe.com

The researchers analyzed patients 65 years or older with a primary diagnosis of COPD admitted to the Department of Respiratory and Critical Care Medicine at a university hospital in southwestern China between March 2021 and September 2022.

Based on the GLIM criteria, the primary outcome variables included malnutrition, length of hospital stay, hospitalization costs, and hospital readmission within 180 days pos -discharge, all obtained from electronic medical records. The GLIM criteria diagnose patients with malnutrition if they have 1 phenotype and 1 etiological type; COPD, an inflammatory condition, fulfills one of the etiological criteria.

The study population consisted of 319 older hospitalized patients with COPD; 209 (65.52%) were male patients and 110 (34.48%) were female patients. The median (IQR) age of the study population was 76 years (70-82), and the median length of stay was 12 days; the total hospital cost was CN¥13,714.78. Additionally, nearly 60 patients had severe (33.54%) or very severe (26.33%) airflow obstruction. As for comorbidities, the median number was 5 (range, 3-7), with 83 (49.53%) patients considered malnourished based on the GLIM criteria.

The researchers noted that patients without malnutrition had significantly better laboratory values for lymphocytes, total protein (TP), albumin (ALB), and hemoglobin (Hb) than those with malnutrition; Hb, ALB, TP, and lymphocytes are considered pivotal indicators of nutrition status in patients with COPD.⁶

Additionally, patients without malnutrition had a median hospital stay of 11 (8-14) days and a total cost of CN¥112,482.8 (CN¥18966.32-CN¥116,608.9).¹ In comparison, those with malnutrition had a median hospital stay of 13 (10-15.25) days and a total cost of CN¥114,423.59 (CN¥110,485.99-CN¥120,878.19).

Similarly, the 180-day readmission rate was significantly lower among patients without malnutrition than those with malnutrition (10.56% vs 30.38%; P < .001). Based on a logistic regression analysis, malnutrition (odds ratio [OR], 3.184; 95% CI, 1.687-6.009; P < .001), having 3 or more comorbidities (OR, 5.754; 95% CI, 1.305-25.379; P = .021), and very severe airway obstruction (OR, 3.735; 95% CI, 1.784-7.822; P < .001) were significant risk factors for hospital readmission within the subsequent 180 days.

The researchers acknowledged their limitations, including this being a cross-sectional study. Therefore, they could not determine causal relationships among the factors. Also, the study population consisted of older hospitalized patients with COPD, so the findings may not be generalizable to those in the community or rehabilitation centers. Despite their limitations, the researchers suggested ways to improve clinical outcomes based on their findings.

“...it is crucial to monitor the nutritional status of hospitalized elderly patients with COPD, identify malnourished patients promptly, and actively improve their nutritional status to reduce adverse clinical outcomes,” the authors concluded.

References

1. Liu H, Song J, Wang Z, et al. Investigation of nutrition status and analysis of 180-day readmission factors in elderly hospitalized patients with COPD. Aging Clin Exp Res. 2024;36(1):155. doi:10.1007/s40520-024-02820-9

2. Deng M, Lu Y, Zhang Q, Bian Y, Zhou X, Hou G. Global prevalence of malnutrition in patients with chronic obstructive pulmonary disease: Systemic review and meta-analysis. Clin Nutr. 2023;42(6):848-858. doi:10.1016/j.clnu.2023.04.005

3. Mao Y, Wu J, Liu G, et al. Chinese expert consensus on prevention and intervention for the elderly with malnutrition (2022). Aging Med (Milton). 2022;5(3):191-203. doi:10.1002/agm2.12226

4. Marco E, Sánchez-Rodríguez D, Dávalos-Yerovi VN, et al. Malnutrition according to ESPEN consensus predicts hospitalizations and long-term mortality in rehabilitation patients with stable chronic obstructive pulmonary disease. Clin Nutr. 2019;38(5):2180-2186. doi:10.1016/j.clnu.2018.09.014

5. Cederholm T, Jensen GL, Correia MITD, et al. GLIM criteria for the diagnosis of malnutrition - a consensus report from the global clinical nutrition community. Clin Nutr. 2019;38(1):1-9. doi:10.1016/j.clnu.2018.08.002

6. Taberna DJ, Navas-Carretero S, Martinez JA. Current nutritional status assessment tools for metabolic care and clinical nutrition. Curr Opin Clin Nutr Metab Care. 2019;22(5):323-328. doi:10.1097/MCO.0000000000000581