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Unintentional Weight Loss as a Predictor of Adverse Prognosis in Older Adults With Chronic Obstructive Pulmonary
Hongtao Cheng1, Yonglan Tang2, Shanyuan Tan3
1School of Nursing, Sun Yat-sen University, Guangzhou, China; Clinical Research Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
Background:
Unintentional weight loss (UWL) is a common occurrence in older patients with chronic obstructive pulmonary disease (COPD). However, it may be overlooked in the intensive care unit (ICU) setting. Despite this, limited research is available on its impact as an independent clinical prognostic factor.
Objective:
To investigate the impact of UWL on the prognosis of critically ill older patients with COPD.
Design:
A retrospective cohort study was conducted in which all participants were followed for at least 1 year.
Participants/Setting:
The study included 2767 patients diagnosed with COPD (aged 65 years and older) from a tertiary academic medical center in Boston, MA, between 2008 and 2019.
Main Outcome Measures:
Exposure was UWL, and study outcomes included 30-day, 90-day, and 360-day mortality and prevalence of pressure injuries.
Statistical Analyses:
Wilcoxon rank-sum and χ2 tests were used to compare cohort characteristics, and Kaplan-Meier survival analysis, Cox proportional hazards regression, logistic regression models, and subgroup analyses were used to examine the relationship between UWL and outcomes. Causal mediation analysis was used to examine potential mediating variables.
Results:
The mean age of participants was approximately 77 years, and 51.9% were male. Of these, 409 older individuals had UWL. The results showed that UWL was significantly associated with increased 30-day (adjusted hazard ratio [aHR], 1.7; 95% confidence interval [CI], 1.3-2.1; P < .001), 90-day (aHR, 1.6; 95% CI, 1.4-2.0; P < .001), and 360-day mortality (aHR, 1.6; 95% CI, 1.4-1.8; P < .001). UWL was associated with an increased prevalence of pressure injuries (adjusted odds ratio, 1.6; 95% CI, 1.2-2.1; P < .001). Pressure injuries partially mediated the relationship between UWL and 30-day mortality (proportion mediated, 16.7%).
Conclusions:
This study demonstrated that UWL was a risk factor for poor prognosis in older COPD patients in the ICU. It is recommended that the UWL assessment be included in the routine assessment of these older patients.
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