Muscle loss contributes to higher morbidity and mortality in COPD: An analysis of national trends

• Published in: Respirology (Carlton, Vic.) Vol. 26; no. 1; pp. 62 - 71
• Main Authors: Attaway, Amy H., Welch, Nicole, Hatipoğlu, Umur, Zein, Joe G., Dasarathy, Srinivasan
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01-01-2021; Wiley Subscription Services, Inc
• Subjects: Cachexia; Chronic obstructive pulmonary disease; Diagnosis; emphysema; Genotype & phenotype; Hospitalization; Morbidity; Mortality; mortality outcomes; Phenotypes; Resource utilization; Respiratory diseases; sarcopenia; Skeletal muscle; United States > US; mortality outcomes; cachexia; chronic obstructive pulmonary disease; emphysema; sarcopenia
• ISSN: 1323-7799; 1440-1843
• DOI: 10.1111/resp.13877

ABSTRACT
Background and objective
COPD is the third most common cause of death worldwide and fourth most common in the United States. In hospitalized patients with COPD, mortality, morbidity and healthcare resource utilization are high. Skeletal muscle loss is frequent in patients with COPD. However, the impact of muscle loss on adverse outcomes has not been systematically evaluated. We tested the hypothesis that patients hospitalized for COPD exacerbation with, compared to those without, a secondary diagnosis of muscle loss phenotype (all ICD‐9 codes associated with muscle loss including cachexia) will have higher mortality and cost of care.
Methods
The NIS database of hospitalized patients in 2011 (1 January–31 December) in the United States was used. The impact of a muscle loss phenotype on in‐hospital mortality, LOS and cost of care for each of the 174 808 hospitalizations for COPD exacerbations was analysed.
Results
Of the subjects admitted for a COPD exacerbation, 12 977 (7.4%) had a secondary diagnosis of muscle loss phenotype. A diagnosis of muscle loss phenotype was associated with significantly higher in‐hospital mortality (14.6% vs 5.7%, P < 0.001), LOS (13.3 + 17.1 vs 5.7 + 7.6, P < 0.001) and median hospital charge per patient ($13 947 vs $6610, P < 0.001). Multivariate regression analysis showed that muscle loss phenotype increased mortality by 111% (95% CI: 2.0–2.2, P < 0.001), LOS by 68.4% (P < 0.001) and the direct cost of care by 83.7% (P < 0.001) compared to those without muscle loss.
Conclusion
In‐hospital mortality, LOS and healthcare costs are higher in patients with COPD exacerbations and a muscle loss phenotype.
Using a large national data set of patients admitted for a COPD exacerbation with and without muscle loss phenotype, we showed that mortality, LOS and cost are considerably higher in patients with muscle loss phenotype. We demonstrated the need for targeted interventions to improve outcomes for patients with COPD.
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