Weight Loss is a Reversible Factor in the Prognosis of Chronic Obstructive Pulmonary Disease
A Schols;J Slangen;L Volovics;E Wouters;
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Weight Loss is a Reversible Factor in the Prognosis of Chronic Obstructive Pulmonary DiseaseSchols AMWJ, Slangen J, Volovics L, Wouters EFM Am J Respir Crit Care Med 1998;157:1791-1797Background. Weight loss in patients with chronic obstructive pulmonary disease (COPD) is associated with an increased mortality (based on retrospective studies) and reduced physical performance and respiratory muscle function. Long-term associations on weight maintenance (or weight gain) with morbidity and mortality are yet unknown.Purpose. To evaluate the prognostic significance of body weight changes in patients with COPD.Materials and Methods. Survival analysis was performed on two groups of patients with COPD: a retrospective study of 400 patients, none of whom had received nutritional therapy, and a post hoc analysis of 203 patients who had participated in a randomized placebo-controlled trial. Baseline characteristics of all patients were collected on admission to a pulmonary rehabilitation program. Mortality was assessed as overall mortality. The Cox proportional hazards model was used to quantify the relationship between the variables.Results. The retrospective study revealed that low body mass index (P < 0.001), age (P < 0.0001), and low arterial oxygen pressure (P < 0.05) were significant independent predictors of increased mortality. After stratification of the group into body mass index quintiles, a threshold value of 25 kg/m2 was identified below which the mortality risk was clearly increased. In the prospective study, weight gain (0.2 kg/8 week) in depleted and nondepleted patients was a significant predictor of survival.Conclusion. The combined results of the two survival analyses provide evidence to support the hypothesis that body weight had an independent effect on survival in COPD. The negative effect of low body weight can be reversed by appropriate therapy in some of the patients with COPD.Comment. This study provides further evidence that a low body weight in patients with COPD is associated with decreased survival. Active attempts to reverse low body weight may play an important role in the treatment of patients with COPD.