Impact of Nutritional Status and Sarcopenia on Acute Exacerbation Risk in Stable Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study.

BACKGROUND

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) drive disease progression and mortality. This study aims to investigate whether nutritional risk and sarcopenia independently predict (AECOPD) in patients with stable COPD.

METHODS

In this single-center retrospective cohort study, 264 hospitalized patients with stable COPD were followed for 12 months. Nutritional risk was assessed using the Nutritional Risk Screening 2002. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. Appendicular skeletal muscle index (ASMI), handgrip strength, gait speed, and five-repetition sit-to-stand (5STS) time were measured. Independent predictors of AECOPD were identified using multivariable logistic regression. Discrimination was evaluated using the area under the receiver operating characteristic curve (AUC).

RESULTS

During follow-up, 102 patients (38.6%) developed AECOPD. Patients with AECOPD exhibited higher rates of sarcopenia (64.71% vs. 32.72%, P < 0.001) and nutritional risk (64.71% vs. 39.51%, P < 0.001), alongside lower ASMI, reduced handgrip strength, slower gait speed, and prolonged 5STS time (all P < 0.01). After adjustment for age, sex, smoking history, forced expiratory volume in 1 second (FEV1)% predicted, and prior AECOPD, and comorbidity burden, both sarcopenia (OR 6.265, 95% CI 3.008-13.049) and nutritional risk (OR 3.016, 95% CI 1.571-5.793) remained independent predictors. ASMI demonstrated a protective association (OR 0.266, 95% CI 0.177-0.399), while TNF-α was positively associated with AECOPD risk (OR 1.175, 95% CI 1.044-1.322). The ASMI-based model achieved the highest discrimination (AUC 0.893).

CONCLUSION

Sarcopenia and nutritional risk independently increase AECOPD risk in stable COPD. Incorporating muscle mass parameters into risk stratification may improve predictive accuracy.