Patients with Obesity Have Better Long-Term Outcomes after Hospitalization for COPD Exacerbation

DeLapp, David; Glick, Connor; Furmanek, Stephen; Ramírez, Julio; Cavallazzi, Rodrigo

doi:10.1080/15412555.2020.1781805

Cited by 26 publications

(15 citation statements)

References 25 publications

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“…This result of ours is corroborated by a large prospective registry study of 5334 enrolled patients in China [37]. Patients comorbid with DM tended to incur higher direct medical costs and stay in the hospital longer; however, the in-hospital mortality of patients with COPD comorbid with DM did not increase in the Chinese cohort [37]. Regarding the role of BMI and long-term mortality in COPD, a Chinese study reported that being underweight is a risk factor for people over 75 years old and being overweight reduces all-cause mortality in older adult patients with COPD.…”

Section: Discussionsupporting

confidence: 86%

“…Comorbidity with DM, CAD, CVA was not associated with short-term or long-term mortality, unlike that in other studies [20,35,36]. This result of ours is corroborated by a large prospective registry study of 5334 enrolled patients in China [37]. Patients comorbid with DM tended to incur higher direct medical costs and stay in the hospital longer; however, the in-hospital mortality of patients with COPD comorbid with DM did not increase in the Chinese cohort [37].…”

Section: Discussionsupporting

confidence: 78%

“…Regarding the role of BMI and long-term mortality in COPD, a Chinese study reported that being underweight is a risk factor for people over 75 years old and being overweight reduces all-cause mortality in older adult patients with COPD. A clinical trial conducted in the United States in 2020 indicated that patients with a BMI of more than 30 were associated with reduced mortality of 1.5 years following COPD [37].…”

Section: Discussionmentioning

confidence: 99%

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Statins Associated with Better Long-Term Outcomes in Aged Hospitalized Patients with COPD: A Real-World Experience from Pay-for-Performance Program

Chen

et al. 2022

JPM

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Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. Previous studies have addressed the impact of comorbidity on short-term mortality in patients with COPD. However, the prevalence of cardiovascular disease (CVD) and the association of statins prescription with mortality for aged COPD patients remains unclear. We enrolled 296 aged, hospitalized patients who were monitored in the pay-for-performance (P-4-P) program of COPD. Factors associated with long-term mortality were identified by Cox regression analysis. The median age of the study cohort was 80 years old, and the prevalence of coronary artery disease (CAD) and statins prescriptions were 16.6% and 31.4%, respectively. The mortality rate of the median 3-year follow-up was 51.4%. Through multivariate analysis, body mass index (BMI), statin prescription, and events of respiratory failure were associated with long-term mortality. A Cox analysis showed that statins prescription was associated with lower mortality (hazard ratio (HR): 0.5, 95% Confident interval, 95% CI: 0.34–0.73, p = 0.0004) and subgroup analysis showed that rosuvastatin prescription had protective effect on long-term mortality (HR: 0.44; 95% CI: 0.20–0.97; p < 0.05). Statin prescriptions might be associated with better long-term survival in aged COPD patients, especially those who experienced an acute exacerbation of COPD (AECOPD) who require hospitalization.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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Statins Associated with Better Long-Term Outcomes in Aged Hospitalized Patients with COPD: A Real-World Experience from Pay-for-Performance Program

Chen

et al. 2022

JPM

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“…This secondary analysis of two large international COPD studies of participants from multiple continents, including a large number of morbidly obese individuals (BMI ⩾40 kg/m 2 ), adds to the current literature by demonstrating that BMI can affect mortality and exacerbation risk in patients with COPD ( 21 – 23 ). An increased risk of CV-related mortality was observed for participants at either end of the BMI scale (BMI < 20 kg/m 2 and BMI ⩾ 35 kg/m 2 ) compared with normal-weight participants (though not reaching significance in TIOSPIR for BMI ⩾ 35 kg/m 2 ).…”

Section: Discussionmentioning

confidence: 94%

Mortality and Exacerbation Risk by Body Mass Index in Patients with COPD in TIOSPIR and UPLIFT

et al. 2022

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Rationale There is an association between body mass index (BMI) and mortality in chronic obstructive pulmonary disease (COPD), with underweight individuals having higher mortality risk. Mortality and exacerbation risks among individuals with higher BMI are unclear. Objectives To examine the relationship between BMI and adverse outcomes in COPD. Methods This post hoc analysis included data from TIOSPIR (Tiotropium Safety and Performance in Respimat) ( N = 17,116) and tiotropium-treated patients in UPLIFT (Understanding Potential Long-term Impacts on Function with Tiotropium) ( N = 2,986). BMI classes (underweight [BMI < 20 kg/m 2 ], normal weight [BMI 20 to <25 kg/m 2 ], overweight [BMI 25 to <30 kg/m 2 ], obesity class I [BMI 30 to <35 kg/m 2 ], obesity class II [BMI 35 to <40 kg/m 2 ], and obesity class III [BMI ⩾ 40 kg/m 2 ]) were examined for adjusted associations with mortality, exacerbation, and nonfatal cardiovascular event risk using over 50,000 patient-years of cumulative follow-up data. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression models. Results In TIOSPIR, obesity prevalence was 22%, overweight 32%, and underweight 12%. The proportion of females was highest in obesity classes II and III. Overweight and obese participants had better baseline lung function versus other BMI classes; underweight participants were more likely to be current smokers. Underweight participants had a significantly higher risk of death (HR, 1.88; 95% CI, 1.62–2.20; P < 0.0001) and severe exacerbations (HR, 1.31; 95% CI, 1.16–1.47; P < 0.0001) versus normal-weight participants; however, overweight and obese participants were at lower to no additional risk. Results from UPLIFT were similar to TIOSPIR. Conclusions These results suggest that there is a strong association between body weight, COPD events, and risk of death. A holistic management approach taking into account respiratory and cardiovascular risk factors and nutritional status is needed to improve the general well-being of patients with COPD.

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“…This paradox is known as the obesity paradox and it was first introduced in 2002 by Gruberg et al, who described an increased mortality rate in obese individuals with coronary artery disease [17]. Since then, numerous studies have been published backing the obesity paradox and showing an increased mortality benefit in conditions such as ischemic stroke, kidney disease, pulmonary disease exacerbation, and coronary artery disease [18][19][20]. The majority of literature outlining and detailing the obesity paradox has been shown through cardiologic, pulmonary, vascular, and renal diseases, but little is known surrounding the obesity paradox and neurosurgical operations, particularly brain operations.…”

Section: Introductionmentioning

confidence: 99%

Mortality Rate of Ischemic Stroke Patients Undergoing Decompressive Hemicraniectomy With Obesity

Hallan¹,

Freedman²,

Rizk³

2022

Cureus

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BackgroundObesity has been shown to have a positive mortality benefit in patients undergoing percutaneous coronary intervention and dialysis and those with rheumatoid arthritis, chronic obstructive pulmonary disease, and various wasting diseases. Studies for this mortality benefit in ischemic stroke patients are conflicting and have not been well studied in hemicraniectomy patients. We sought to determine the impact of obesity on outcomes of hemicraniectomy patients. MethodsWe performed a retrospective case-control database analysis using a multi-institutional database (TriNetX) looking at obese versus non-obese patients with ischemic stroke undergoing hemicraniectomy. Our primary endpoint was mortality. Secondary endpoints included seizure, pulmonary embolism, myocardial infarction (MI), cerebral infarction, deep vein thrombosis, tracheostomy, and percutaneous endoscopic gastrostomy. Cohorts were propensity-score matched for confounders. ResultsAfter propensity score matching for basic demographics and common comorbidities, as well as indicators of stroke severity, 646 patients were identified that were obese and had an ischemic stroke with subsequent hemicraniectomy (cohort 1), and 646 patients were identified who were non-obese with ischemic stroke and hemicraniectomy (cohort 2). Thirty-day survival rate was 98.142% in the obese vs. 87.771% in the non-obese cohorts, 90-day survival was 85.15% vs. 79.35%, 180-day survival was 96.44% vs. 84.52%, 365-day survival was 94.272% vs. 81.734%, and five-year survival was 81.889% vs. 75.077%, respectively. At five years, risk difference was −7.276% (95% CI: −11.757, −2.794) and odds ratio was 0.666 (95% CI: 0.510, 0.871) (p = 0.0029). Despite a higher mortality rate, obese patients had a statistically significant increase in pulmonary embolism (11.61% vs. 5.108, p < 0.0001), deep venous thrombosis (16.873% vs. 9.133%, p < 0.0001), and MI (8.824% vs. 5.882%, p = 0.0428). There was no significant difference in intensive care unit length of stay, ventilator dependence, tracheostomy placement, percutaneous endoscopic gastrostomy placement, or intracerebral hemorrhage. ConclusionsDespite the increased risk of ischemic stroke, obese patients who undergo hemicraniectomy have decreased mortality rates compared to their non-obese counterparts.

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Patients with Obesity Have Better Long-Term Outcomes after Hospitalization for COPD Exacerbation

Cited by 26 publications

References 25 publications

Statins Associated with Better Long-Term Outcomes in Aged Hospitalized Patients with COPD: A Real-World Experience from Pay-for-Performance Program

Statins Associated with Better Long-Term Outcomes in Aged Hospitalized Patients with COPD: A Real-World Experience from Pay-for-Performance Program

Mortality and Exacerbation Risk by Body Mass Index in Patients with COPD in TIOSPIR and UPLIFT

Mortality Rate of Ischemic Stroke Patients Undergoing Decompressive Hemicraniectomy With Obesity

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