It\u2019s more than low BMI: prevalence of cachexia and associated mortality in COPD

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

doi:10.1186/s12931-019-1073-3

Abstract

BackgroundCachexia 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.MethodsIn 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.ResultsAmong 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.ConclusionsCachexia 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.

Highlights

Cachexia is associated with increased mortality risk among chronic obstructive pulmonary disease (COPD) patients
As the current estimates of COPD cachexia have been largely based on low body mass index (BMI), we aimed to estimate the prevalence of cachexia and its associated mortality in a large cohort of COPD cases followed for three years in the ECLIPSE study using two sets of cachexia criteria that we termed consensus and weight-loss (Table 1)
At Year 1, 1483 COPD cases were assessed for the consensus definition of cachexia, and weight-loss associated with cachexia (Additional file 1: Figure S1)

Summary

Introduction

Cachexia is associated with increased mortality risk among chronic obstructive pulmonary disease (COPD) patients. Low body mass index (BMI) as opposed to cachexia is often used, 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. As the current estimates of COPD cachexia have been largely based on low BMI, we aimed to estimate the prevalence of cachexia and its associated mortality in a large cohort of COPD cases followed for three years in the ECLIPSE study using two sets of cachexia criteria that we termed consensus and weight-loss (Table 1). We replaced the low BMI component of BODE with the criteria for consensus and weight-loss cachexia to create the CODE (Cachexia, Obstruction, Dyspnea and Exercise) and WODE (Weight loss, Obstruction, Dyspnea and Exercise) indices and compared performance in terms of mortality prediction

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