Introduction and objectives In patients hospitalised with an acute exacerbation of COPD (AECOPD), low body mass index (BMI) predicts in-hospital death. The Malnutrition Universal Screening Tool (MUST) incorporates BMI and patient-reported weight loss over the previous 6 months to provide an overall assessment of malnutrition risk. It predicts mortality in elderly hospitalised patients1 but, to our knowledge, the prognostic value of this tool in AECOPD has not been previously reported.
Methods We prospectively identified patients hospitalised with AECOPD. We investigated the ability of BMI, self-reported weight loss and MUST score to predict in-hospital mortality and 28-day readmission. BMI <18.5 kgm−2 was considered underweight (World Health Organisation, 2004). Odds Ratios (OR) were calculated using normal BMI, weight loss <5%, and MUST score 0 as reference values.
Results 608 patients were included; mean (SD) age 72.8 (10.2) years, 55.8% female, mean (SD) FEV1 (if performed within 2 years of admission, n=398) 43.5 (18) % predicted. 61 (10%) patients died in-hospital (6.9% in those with simple exacerbations, 16.5% in exacerbations associated with pneumonia). Of patients surviving to discharge, 95 (17.4%) were readmitted within 28 days (Abstract P117 Table 1). In-hospital mortality was predicted by BMI <18.5 kgm−2 (OR 2.5, 95% CI 1.27 to 4.91, p=0.008) whereas weight loss >10% predicted early readmission (OR 3.90, 95% CI 2.09 to 7.28, p<0.001). A high risk of malnutrition (MUST ≥2) was the only measurement that significantly predicted both in-hospital mortality (OR 2.10, 95% CI 1.18 to 3.74, p=0.011) and early readmission to hospital (OR 1.71, 95% CI 1.04 to 2.83, p=0.034). BMI within the overweight range appeared to be protective against early readmission (OR 0.54, 95% CI 0.29 to 0.99, p=0.046).
Conclusion In patients hospitalised with AECOPD, indices of nutritional status are important predictors of outcome. Of interest, BMI and self-reported weight loss predict different outcome measures (in-hospital death and early readmission respectively). A high risk of malnutrition (MUST score ≥2) is potentially a useful predictor of both in-hospital mortality and early hospital readmission and we suggest that it should be assessed routinely.
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