A low Geriatric Nutritional Risk Index (GNRI) score is an independent risk factor for all-cause mortality in patients with chronic obstructive pulmonary disease (COPD), according to study findings published in BMJ Open Respiratory Research.

Researchers evaluated the relationship between malnutrition, based on GNRI score, and all-cause mortality in patients with COPD, using data from the National Health and Nutrition Examination Survey (NHANES) for 2013 to 2014 through 2017 to 2018.

The GNRI is calculated based on serum albumin levels, present body weight, and ideal body weight. Participants with COPD were categorized into 2 groups: malnutrition (GNRI ≤98) and normal nutrition (GNRI >98). The primary outcome was mortality rate.

A total of 579 adults with self-reported COPD were included in the study (mean [SD] age, 63.4 [0.5] years; 53.9% female; 80.9% non-Hispanic White). Malnutrition incidence according to the GNRI was 6.6%, and 541 patients had no nutritional risk based on their GNRI score.

The GNRI is a simple but strong prognostic tool for evaluating the nutritional status of patients with COPD.

A total of 109 (16.5%) participants had died by December 31, 2018. The median follow-up was 37 months (range, 1-85 months). Malnutrition was associated with a higher all-cause cumulative mortality, according to Kaplan-Meier curves of nutritional status for all-cause mortality.

Nutritional status, age, smoking status, hypertension, and congestive heart failure were significant variables in univariate Cox regression analysis. Malnutrition was associated with a significantly increased risk of all-cause mortality (unadjusted model 1: malnutrition hazard ratio [HR]: 2.30; 95% CI, 1.24-4.27; adjusted model 2: malnutrition HR, 2.28; 95% CI, 1.19-4.40; P <.05).

In model 3, which was fully adjusted for all statistically significant variables, the adjusted HR was 2.47 (95% CI, 1.36-4.5; P =.003).

In the subgroup with participants who had low educational levels, the HR for malnutrition was 4.85-fold higher (P <.0001). Among participants who had COPD-related cancers, malnutrition increased the risk of mortality by 328% (P =.01). Malnutrition also increased the risk of mortality in the male subgroup (malnutrition HR, 3.51; 95% CI, 1.72-7.15).

Malnutrition was associated with increased mortality in both age subgroups (for participants aged <65 years: malnutrition HR, 2.42; for those aged ≥65 years: malnutrition HR, 2.71).

Among several limitations, the primary outcome was restricted to all-cause mortality instead of COPD-related mortality, and the study had no time limit. In addition, the sample size of malnutrition based on a low GNRI was small, which could have led to bias. Also, the severity of the airflow limitation could not be carefully considered owing to the absence of spirometric data.

“The GNRI is a simple but strong prognostic tool for evaluating the nutritional status of patients with COPD,” stated the researchers. “We believe that it is convenient and effective to use the GNRI to identify and manage malnutrition. When general practitioners and clinicians develop a treatment plan for patients with COPD, their evaluation of nutritional status and consequent recommendation of precautions may contribute to a reduced risk of mortality and improved prognosis.”

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