Correlation Between Nutritional Status And Clinical Characteristics In Old Stable COPD Patients

Objective:To investigate the current nutritional status of patients with chronic obstructive pulmonary disease(COPD),to analyze the risk factors for the nutritional status of COPD patients and their relationships with the mini-nutritional assessment short form(MNA-SF)scores,and to establish an acute exacerbation-risk forecasting model of stable COPD patients.Methods:From January 1,2017 to May 30,2019,202 old outpatients with stable COPD in the Second Affiliated Hospital of Soochow University were observed and recorded.Three groups with different nutriture were divided according to the MNA-SF scores,which were named as malnourished group(Group A),at-risk group(Group B)and well nourished group(Group C).Parallelly,patients had acute exacerbation no less than two times or leading to hospital admission no less than one time during last year were addressed as a high risk group,whereas the left patients were addressed as a low-risk group.Statistical analysis and comparison were performed by SPSS 25.0.Correlations between the MNA-SF scores and recorded variables were evaluated.Logistic regression analysis was performed for determining the forecasting model of the acute exacerbation in COPD patients with its risk factors and the dependent variable.Finally,receiver-operating characteristics(ROC)curve analysis was used to assess the validity of this model.Results:1.Grouping:30 cases in group A(14.9%),109 cases in group B(54.0%),63 cases in group C(31.1%).hAccoding to the frequency of acute exacerbation last year,131 cases were in high-risk group(64.9%)and 71 cases were in low-risk group(35.1%).2.Patients with different nutriture showed significant differences(P<0.05)in age,forced expiratory volume in one second(FEV1,forced vital capacity(FVC),ratio of FEV1 to FVC(FEV1/FVC),body mass index(BMI),albumin(ALB),prealbumin(PAB),total cholesterol(TC)and triglyceride(TG).With the decrease of MNA-SF scores,the levels of FEV1,FVC,FEV1/FVC,BMI,ALB,PAB,TC,TG significantly reduced,while the age increased.3.The MNA-SF scores were positively correlated with FEV1,BMI,TG,TC,ALB and PAB(r=0.200～0.544,P<0.05),while negatively correlated with age,Modified British Medical Research Council(mMRC)and acute exacerbation within one year(r=-0.488～-0.286,P<0.05).4.MMRC,ALB,PAB and TC were independentfactors of the MNA-SF score(b=-0.923,0.125,5.141,0.744),in which the mMRC classification was the most prominent one(β=-0.341,P<0.001).5.In multivariate logistic regression analysis,the MNA-SF score was an independent risk factor for acute exacerbation of COPD(b=-0.571,P<0.05).and the forecasting model was Logit(P)=4.413-0.586×MNA-SF scores.6.The area under curve of the forecasting model was 0.804,and the accuracy,sensitivity and specificity were 77.4%,79.7%and 72.1%respectively.The cut-off value of the model was MNA-SF ≥ 7,which could be used for forecasting the acute exacerbation-risk of COPD.Conclusion:1.Malnutrition in elderly patients with stable COPD were partly influenced by age,pulmonary function and serum nutrition indicators.2.The lower scores of MNA-SF were accompanied by aggravated dyspnea and lower levels of ALB,PAB and TC in elderly patients with stable COPD.3.The MNA-SF was an independent risk factor for acute exacerbation of COPD,and the obtained model was Logit(P)=4.413-0.586×MNA-SF scores.