TY - JOUR
T1 - It's more than low BMI
T2 - prevalence of cachexia and associated mortality in COPD
AU - McDonald, Merry-Lynn N.
AU - Wouters, Emiel F. M.
AU - Rutten, Erica
AU - Casaburi, Richard
AU - Rennard, Stephen
AU - Lomas, David A.
AU - Bamman, Marcas
AU - Celli, Bartolome
AU - Agusti, Alvar
AU - Tal-Singer, Ruth
AU - Hersh, Craig P.
AU - Dransfield, Mark
AU - Silverman, Edwin K.
N1 - Funding Information:
M-LNM reports grants from National Institutes of Health, other from Parker B. Francis Foundation, during the conduct of the study and personal fees from Pfizer, outside the submitted work. EFMW has received personal fees from Nycomed, Boehringer, AstraZeneca, GSK, Novartis and Chiesi. EFMW has received grants from AstraZeneca and GSK. ER has no competing interests. RC has received personal fees from GSK, Boehringer Ingelheim, Astra Zeneca, Genentech and Regeneron. SIR reports other from AstraZeneca, outside the submitted work. S.I.R. is employed by AstraZeneca. DAL reports grants, personal fees and non-financial support from GSK during the conduct of the study and personal fees from Griffols, outside the submitted work. MB has no competing interests. BC reports personal fees and other from Astra Zeneca, personal fees from GlaxoSmithKline, personal fees from Boehringer Ingelheim, personal fees from Novartis, personal fees from Sanofi Aventis and personal fess form Menarini other from outside the submitted work. AA reports personal fees from GSK, during the conduct of the study. RT-S is an employee and shareholder of GSK, the ECLIPSE study sponsor. CPH reports personal fees from Mylan, personal fees from AstraZeneca, personal fees from Concert Pharmaceuticals, personal fees from 23andMe, grants from Novartis, grants from Boehringer-Ingelheim, grants from NHLBI, outside the submitted work. MD reports grants from Department of Defense, personal fees and other from Boehringer Ingelheim, personal fees and other from GSK, other from Novartis, personal fees and other from AstraZeneca, other from Yungjin, personal fees and other from PneumRx/BTG, other from Pulmonx, personal fees from Genentech, personal fees and other from Boston Scientific, personal fees from Quark Pharmaceuticals, grants from NIH, outside the submitted work. EKS reports grants, personal fees and other from GSK, during the conduct of the study; personal fees from Novartis, outside the submitted work.
Funding Information:
National Institutes for Health grant R00HL121087 and the Parker B. Francis Fellowship Program. ECLIPSE was funded by GSK. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agents.
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/5/22
Y1 - 2019/5/22
N2 - 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.
AB - 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.
KW - COPD
KW - Cachexia
KW - BODE
KW - Weight loss
KW - BMI
KW - FAIL
U2 - 10.1186/s12931-019-1073-3
DO - 10.1186/s12931-019-1073-3
M3 - Article
C2 - 31118043
SN - 1465-993X
VL - 20
JO - Respiratory Research
JF - Respiratory Research
IS - 1
M1 - 100
ER -