- Research
- Open Access
- Published:
Sarcopenia index as a predictor of clinical outcomes among older adult patients with acute exacerbation of chronic obstructive pulmonary disease: a cross-sectional study
BMC Geriatrics volume 23, Article number: 89 (2023)
Abstract
Background
Sarcopenia is a geriatric syndrome with progressive loss of skeletal muscle mass and function and has a negative impact on clinical outcomes associated with chronic obstructive pulmonary disease (COPD). Recently, the sarcopenia index (SI) was developed as a surrogate marker of sarcopenia based upon the serum creatinine to cystatin C ratio. We aimed to assess the value of SI for predicting clinically important outcomes among elderly patients with acute exacerbation of COPD (AECOPD).
Methods
This cross-sectional study included elderly patients with AECOPD in China from 2017 to 2021. Clinical data were collected from medical records, and serum creatinine and cystatin C were measured. Outcomes included respiratory failure, heart failure, severe pneumonia, invasive mechanical ventilation, and mortality. Binary logistic regression was used to analyze the association between SI and clinical outcomes.
Results
A total of 306 patients (260 men, 46 women, age range 60–88 years) were enrolled in this study. Among the total patients, the incidence of respiratory failure and severe pneumonia was negatively associated with SI values. After adjusting for potential confounding factors, binary logistic regression analyses showed that a higher SI was still independently associated with a lower risk of respiratory failure (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.13–0.56, P < 0.05). In subgroup analysis, the incidence of respiratory failure was negatively associated with SI values in groups with both frequent exacerbation and non-frequent exacerbation. After adjustment for potential confounders, binary logistic regression analyses showed that a higher SI was also independently associated with a lower risk of respiratory failure in both groups (OR: 0.19, 95% CI: 0.06–0.64 and OR: 0.31, 95% CI: 0.11–0.85). However, there were no significant differences in the correlations between SI and the risk of heart failure, invasive mechanical ventilation, and mortality in all groups.
Conclusion
The SI based on serum creatinine and cystatin C can predict respiratory failure in patients with AECOPD and either frequent or infrequent exacerbations. This indicator provides a convenient tool for clinicians when managing patients with AECOPD in daily clinical practice.
Background
Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases and an important health care problem in older adults [1]. On average, each patient with COPD generally experiences 0.5 to 3.5 episodes of acute exacerbation annually [2]. Previous studies have reported that exacerbation contributes to an accelerated decline in lung function, reduced health status and quality of life, and increased risk of death [3,4,5]. Therefore, the prevention of COPD exacerbation is an active area of research.
Sarcopenia is a syndrome characterized by a progressive decline in skeletal muscle mass, strength, and function in older people [6]. It is closely related to osteoporosis and frailty syndrome and can increases the risks for adverse health outcomes such as falls, physical disability, hospital admission, poor quality of life, and mortality risk [7, 8]. In patients with COPD, sarcopenia is a common comorbidity and its prevalence is estimated to range from 15 to 55% [9]. Studies have shown that sarcopenia has a negative impact on a range of COPD-related clinical outcomes, including exercise capacity, balance, quadriceps and handgrip strength, gait speed, and physical activity levels, which results in impaired physical capacity, reduced health-related quality of life, frequent hospital admissions, increased health care utilization, and even mortality [9,10,11]. In turn, COPD exacerbations can rapidly induce loss of muscle mass and function [12]. Together, these form a vicious circle that accelerates COPD progression. Consequently, early identification of sarcopenia in patients with COPD, especially acute exacerbation of COPD (AECOPD), has crucial importance in clinical practice.
Traditional screening tests recommended for sarcopenia have limited use in clinical practice owing to high costs, radiation exposure, and requirements for highly specialized personnel [13]. Recently, the sarcopenia index (SI; serum creatinine [Cr, mg/dL]/cystatin C [CysC, mg/L] × 100) has been recommended as a novel screening tool for sarcopenia [14, 15]. Because the SI can be conveniently obtained using serologic findings in hospitalized patients, the index has been received increasing research interest. Studies have found that SI can predict the risk of complications after hip fracture in older adults, the future incidence of major adverse cardiovascular events in patients with obstructive coronary artery disease, and can be a promising biomarker for depressive symptoms in men [13, 16, 17]. However, the value of the SI in patients with AECOPD has not been reported to date. Thus, we sought to evaluate the relationship between the SI and clinical outcomes in elderly patients with AECOPD.
Methods
Data source
The data used in this study were part of a national key research and development project on COPD in China; this was a national clinical registration study initiated in June 2017 that lasted for 3.5 years (Clinical Trials ID: NCT03187236).
Study cohort
Study participants were inpatients from the Department of Respiratory and Critical Care Medicine and the Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, China. All patients were over 60 years old, and diagnosed with AECOPD, following the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) [18]. That study was approved by the Ethics Committee of the Affiliated Hospital of Guangdong Medical University and was conducted in accordance with the Declaration of Helsinki. Participants were informed of the purpose of the study and signed a consent form. Between 2017 and 2021, 366 participants were enrolled in the study. Owing to the different clinical outcomes among patients with frequent exacerbation (participants who experienced two or more exacerbations within the past year) and without frequent exacerbation [19], we analyzed the association of SI and clinical outcomes separately according to the COPD phenotype. We excluded patients with incomplete data (n = 20), chronic kidney disease with serum Cr 2.0 mg/dL (n = 8) or acute kidney injury (increase in serum Cr levels to ≥ 1.5 times the baseline value that is known or presumed to have occurred within the prior 7 days) (n = 7), active cancer (n = 3), co-existing conditions such as musculoskeletal and neurological disorders (n = 2), and concomitant respiratory diseases other than COPD, such as asthma and bronchiectasis (n = 20). Thus, 306 participants were included in the final study sample.
Clinical and laboratory measurements and spirometry
Demographic characteristics (age, sex, height, weight, body mass index (BMI), smoking history) and clinical characteristics, including comorbidities (diabetes, hypertension, coronary disease, and arrhythmia), COPD Assessment Test (CAT) score, modified Medical Research Council (mMRC) score, exacerbation history, arterial blood gas analysis, white blood cell (WBC), C-reactive protein (CRP), and albumin (ALB) were collected from the hospital database and the data management network (mzf.fwncpc.com).
Cr was measured via the picric acid method. Serum CysC was measured via latex enhanced immune turbidimetry; the assay details are as follows. Buffer-diluted serum samples were mixed with latex covalently bound antibodies to form stable antigen–antibody complexes, resulting in a certain degree of turbidity. By measuring the absorbance of the mixture and comparing it with the calibration solution under the same conditions, the concentration of CysC in the sample could be calculated. The SI was calculated using the following formula: serum Cr/CysC value × 100 [14]. According to the SI values, all participants were divided into two groups: low or high SI. The SI median was used as the cutoff value, with low SI defined as lower than the median and high SI defined as equal to or higher than the median. All measurements were conducted in our hospital’s clinical laboratory. We performed spirometry according to the guidelines for lung function tests formulated by the Chinese Thoracic Society. We measured percentage predicted forced expiratory volume in 1 s (FEV1% predicted) in all participants.
Clinical outcome measures
Clinical outcomes, defined according to the International Classification of Disease Tenth Revision (ICD-10) (respiratory failure, heart failure, severe pneumonia, invasive mechanical ventilation, and mortality), were obtained from the hospital database.
Statistical analysis
All statistical analyses were performed with IBM SPSS Statistics, Version 25.0, (IBM Corp., Armonk, NY, USA) with the statistical significance level set at P less than 0.05 (P < 0.05). Categorical data are reported as number (percentage). Continuous variables are presented as mean ± standard deviation (SD) for normally distributed data. The chi-square test was used for comparisons of categorical variables, and the independent t-test was used for the comparison of normally distributed continuous variables. Binary logistic regression analysis was used to analyze the association between SI and clinical outcomes. Two models were used in this regression analysis. Model 1 was unadjusted; model 2 was adjusted for confounder variables, including age, sex, smoking history, BMI, FEV1% predicted, WBC, CRP, ALB, GOLD grade (severity grading of COPD), CAT score, mMRC score, and comorbidities (diabetes, hypertension, coronary disease, arrhythmia). We adjusted for these variables, which we thought were related to the clinical outcomes.
Results
Demographic and clinical characteristics
In total, 306 patients with AECOPD were included: 260 (85.0%) male patients and 46 (15.0%) female patients (mean age: 71.29 SD: 7.09, range: 60–88 years). We divided all participants into two groups: those with non-frequent exacerbation and those with frequent exacerbation. In this study, 200 (65.4%) patients had non-frequent exacerbation and 106 (34.6%) had frequent exacerbation. Participants were further divided into two groups according to the median SI. Low SI was defined as SI < 91.75 for all participants, SI < 82.94 for participants in the frequent exacerbation group, and SI < 101.41 for participants in the non-frequent exacerbation group. Participants with SI equal to or above these medians were defined as having a high SI. We observed that the two groups differed significantly in BMI, FEV1% predicted, ALB level, GOLD grade, CAT score, and mMRC score among all participants. There were significant differences between the two SI groups for patients with non-frequent exacerbation in terms of BMI and ALB level; patients with frequent exacerbation differed in BMI between the low and high SI groups (Table 1).
Clinical outcomes
The clinical outcomes observed in this study included respiratory failure, heart failure, severe pneumonia, invasive ventilation, and mortality. In the total patients, the incidences of respiratory failure and severe pneumonia were significantly associated with low SI; the incidence of respiratory failure was also significantly associated with low SI in both the frequent exacerbation and non-frequent exacerbation groups. However, there were no significant differences in the incidence of heart failure, severe pneumonia, invasive mechanical ventilation, and mortality between the groups with low SI and high SI in the frequent exacerbation and non-frequent exacerbation groups (Table 2).
In the total patients, model 1 showed that a higher SI was associated with the risk of respiratory failure and severe pneumonia. After adjustment for potential confounding factors, model 2 showed that a higher SI was only independently associated with a lower risk of respiratory failure (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.13–0.56). In subgroup analysis, model 1 showed that a higher SI was associated with the risk of respiratory failure in both the frequent exacerbation and non-frequent exacerbation groups. After adjustment for potential confounders, model 2 showed that a higher SI was also independently associated with a lower risk of respiratory failure in both groups (OR: 0.19, 95% CI: 0.06–0.64 and OR: 0.31, 95% CI: 0.11–0.85). However, there were no significant differences in the correlations between SI and the risk of heart failure, severe pneumonia, invasive mechanical ventilation, and mortality for both groups (Table 3).
Discussion
In this cross-sectional study, we investigated a sample of 306 patients with AECOPD between the ages of 60 and 88 years to evaluate the role of SI in predicting clinical outcomes among elderly patients with AECOPD. We also reported stratified results according to the AECOPD phenotype.
Our results showed that, regardless of group (total, frequent exacerbation group, or non-frequent exacerbation group), the incidence of respiratory failure was negatively associated with SI values. After adjustment for potential confounding factors, binary logistic regression analyses showed that a higher SI was also independently associated with a lower risk of respiratory failure, suggesting that the SI is a stable indicator predicting the risk of respiratory failure among patients with AECOPD. The SI is a simple and low-cost indicator that has been recommended as a novel screening tool for sarcopenia [15]. Poor nutritional status can contribute to decreased muscle mass and strength; therefore, nutritional status plays an important role in the development of sarcopenia [20, 21]. Owing to limited caloric intake and increased energy expenditure, patients with COPD complicated by respiratory failure often have protein-calorie malnutrition [22]. When the patient is having an acute episode of COPD, skeletal muscle dysfunction can be caused by hypoxia and/or hypercapnia, malnutrition, a strong inflammatory response, and the use of corticosteroids [23]. Therefore, sarcopenia is highly prevalent among patients with AECOPD complicated by respiratory failure. Furthermore, studies have shown that sarcopenia can have an impact on diaphragm muscle fatigue and can reduce respiratory muscle strength, including maximum inspiratory muscle pressure and maximum expiratory pressure [24,25,26]. These findings suggest that sarcopenia can increase the risk of respiratory failure in patients with AECOPD. Hence, we believe that the SI may predict respiratory failure among patients with AECOPD. Respiratory failure is a common complication in these patients. In severe cases, patients may be agitated, combative, or delirious, or they may lose consciousness and fall into a coma, thereby endangering their lives [27, 28]. Previous studies have shown that respiratory failure can increase the frequency of admissions to the emergency department or intensive care unit and is associated with significant mortality among patients with AECOPD [29, 30]. Therefore, routinely assessing the SI in the management of patients with AECOPD would facilitate more accurate early intervention, resulting in a reduced respiratory failure-related burden of the disease.
A systematic review and meta-analysis showed that sarcopenia and heart failure often co-exist, and the prevalence estimates of sarcopenia vary between 10 and 69% in patients with heart failure [31]. Both sarcopenia and heart failure share common pathophysiological pathways involving muscle dysfunction, which include alterations in mitochondrial density and activity, fiber distribution, and oxidative stress [32]. However, previous studies haven't focused on particular type of heart failure [33]. In our study, we did not find an association between SI and heart failure among older patients with AECOPD. The possible reason is that heart failure in our study was mainly right heart failure caused by chronic pulmonary heart diseases. It is well known that strong respiratory muscles can generate effective coughing that clears the airways and prevents pneumonia; in turn, if respiratory muscles are weak, this results in an increased propensity for pneumonia development. Sarcopenia is reported as a risk factor for the development of pneumonia in elderly people; several reports have also revealed the association between pneumonia and sarcopenia [16, 34, 35]. However, in our study, we detected no correlation between SI and severe pneumonia in patients overall, the group with frequent exacerbation, or the group without frequent exacerbation. Other studies have reported that sarcopenia is associated with mechanical ventilation and mortality among patients in the intensive care unit [36, 37], but there is no correlation between the SI and invasive mechanical ventilation or mortality among patients with AECOPD. It may be that the incidence of severe pneumonia, invasive mechanical ventilation, and mortality in our study was very low. More in-depth research with a larger sample size is needed.
Although as far as we know, this was the first study to evaluate the role of the SI in predicting clinical outcomes among patients with AECOPD, our study has certain limitations. First, this study was carried out at a single institution and included a small sample size. Additionally, most participants were men, which would lead to sex bias. Second, we did not have information for certain confounders, such as education level, income status, or medication complexity; these factors may confound the relationship between the SI and clinical outcomes among patients with AECOPD. Third, we did not use BIA or DXA to assess actual residual muscle mass in our patients. Finally, the inpatients in our study are not representative of patients with AECOPD in the general population or other clinical settings. Our sample is only representative of elderly patients with AECOPD in the Department of Respiratory and Critical Care Medicine and the Department of Geriatrics.
Sarcopenia is a complex and highly disabling disease that crucially affect the physical function and physical performance in elderly people with chronic disease, resulting in worsening disability, health-related quality of life, the need for assistance, detrimental implications for social and sanitary costs, and challenges in the therapeutic management [38]. Our study showed that the SI, based on serum Cr and CysC, can predict respiratory failure in elderly patients with AECOPD, suggesting that SI might be a simple, low-cost and stable indicator. Clinicians need to consider use SI as a critical indicator for the management of elderly patients with chronic diseases, including COPD.
Availability of data and materials
The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.
Abbreviations
- COPD:
-
Chronic obstructive pulmonary disease
- AECOPD:
-
Acute exacerbation of COPD
- SI:
-
Sarcopenia index
- Cr:
-
Creatinine
- CysC:
-
Cystatin C
- GOLD:
-
Global Initiative for Chronic Obstructive Lung Disease
- BMI:
-
Body mass index
- CAT:
-
COPD Assessment Test
- mMRC:
-
Modified Medical Research Council
- WBC:
-
White blood cell
- CRP:
-
C-reactive protein
- ALB:
-
Albumin
- FEV1% predicted:
-
Percentage predicted forced expiratory volume in 1 s
- ICD-10:
-
International Classification of Diseases Tenth Revision
- SD:
-
Standard deviation
- OR:
-
Odds ratio
- CI:
-
Confidence interval
- BIA:
-
Bioelectrical impedance analysis
- DXA:
-
Dual-energy x-ray absorptiometry
References
Celli BR, Wedzicha JA. Update on Clinical Aspects of Chronic Obstructive Pulmonary Disease. N Engl J Med. 2019;381(13):1257–66.
Cai B-q, Cai S-x, Chen R-c, Cui L-y, Feng Y-l, Gu Y-t, et al. Expert consensus on acute exacerbation of chronic obstructive pulmonary disease in the People’s Republic of China. Int J Chron Obstruct Pulmon Dis. 2014;9:381–95.
Donaldson GC, Seemungal TAR, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002;57(10):847–52.
Hillas G, Perlikos F, Tzanakis N. Acute exacerbation of COPD: is it the “stroke of the lungs”? Int J Chron Obstruct Pulmon Dis. 2016;11:1579–86.
Ritchie AI, Wedzicha JA. Definition, Causes, Pathogenesis, and Consequences of Chronic Obstructive Pulmonary Disease Exacerbations. Clin Chest Med. 2020;41(3):421–38.
Chen L-K, Liu L-K, Woo J, Assantachai P, Auyeung T-W, Bahyah KS, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014;15(2):95–101.
Lippi L, Folli A, Curci C, D’Abrosca F, Moalli S, Mezian K, et al. Osteosarcopenia in Patients with Chronic Obstructive Pulmonary Diseases: Which Pathophysiologic Implications for Rehabilitation? Int J Environ Res Public Health. 2022;19(21):14314.
Álvarez-Bustos A, Rodríguez-Sánchez B, Carnicero-Carreño JA, Sepúlveda-Loyola W, Garcia-Garcia FJ, Rodríguez-Mañas L. Healthcare cost expenditures associated to frailty and sarcopenia. BMC Geriatr. 2022;22(1):747.
Sepúlveda-Loyola W, Osadnik C, Phu S, Morita AA, Duque G, Probst VS. Diagnosis, prevalence, and clinical impact of sarcopenia in COPD: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2020;11(5):1164–76.
Langen RCJ, Gosker HR, Remels AHV, Schols AMWJ. Triggers and mechanisms of skeletal muscle wasting in chronic obstructive pulmonary disease. Int J Biochem Cell Biol. 2013;45(10):2245–56.
Hillas G, Perlikos F, Tsiligianni I, Tzanakis N. Managing comorbidities in COPD. Int J Chron Obstruct Pulmon Dis. 2015;10:95–109.
Martínez-Llorens JM, Orozco-Levi M, Masdeu MJ, Coronell C, Ramírez-Sarmiento A, Sanjuas C, et al. Global muscle dysfunction and exacerbation of COPD: a cohort study. Med Clin (Barc). 2004;122(14):521–7.
Lu Y-W, Tsai Y-L, Chou R-H, Kuo C-S, Chang C-C, Huang P-H, et al. Serum creatinine to cystatin C ratio is associated with major adverse cardiovascular events in patients with obstructive coronary artery disease. Nutr Metab Cardiovasc Dis. 2021;31(5):1509–15.
Kashani KB, Frazee EN, Kukrálová L, Sarvottam K, Herasevich V, Young PM, et al. Evaluating Muscle Mass by Using Markers of Kidney Function: Development of the Sarcopenia Index. Crit Care Med. 2017;45(1):e23–9.
Hirai K, Tanaka A, Homma T, Goto Y, Akimoto K, Uno T, et al. Serum creatinine/cystatin C ratio as a surrogate marker for sarcopenia in patients with chronic obstructive pulmonary disease. Clin Nutr. 2021;40(3):1274–80.
Chen X, Shen Y, Hou L, Yang B, Dong B, Hao Q. Sarcopenia index based on serum creatinine and cystatin C predicts the risk of postoperative complications following hip fracture surgery in older adults. BMC Geriatr. 2021;21(1):541.
Zhu Y, Guo X, Zhang X, Shi X, Yang Y, Zhang Q. Sex differences in the relationship of serum creatinine to cystatin C ratio and depressive symptoms among middle-aged and older adults in China. J Affect Disord. 2022;319:57–61.
Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med. 2017;195(5):557–82.
Lu F-Y, Chen R, Li N, Sun X-W, Zhou M, Li Q-Y, et al. Neutrophil-to-Lymphocyte Ratio Predicts Clinical Outcome of Severe Acute Exacerbation of COPD in Frequent Exacerbators. Int J Chron Obstruct Pulmon Dis. 2021;16:341–9.
Gropper SS, Tappen RM, Vieira ER. Differences In Nutritional And Physical Health Indicators Among Older African Americans, European Americans, And Hispanic Americans. J Nutr Gerontol Geriatr. 2019;38(3):205–17.
Ma K, Huang F, Qiao R, Miao L. Pathogenesis of sarcopenia in chronic obstructive pulmonary disease. Front Physiol. 2022;13: 850964.
Chen R, Xing L, You C, Ou X. Prediction of prognosis in chronic obstructive pulmonary disease patients with respiratory failure: A comparison of three nutritional assessment methods. Eur J Intern Med. 2018;57:70–5.
Ramos E, de Oliveira LVF, Silva AB, Costa IP, Corrêa JCF, Costa D, et al. Peripheral muscle strength and functional capacity in patients with moderate to severe asthma. Multidiscip Respir Med. 2015;10(1):3.
Fogarty MJ, Mantilla CB, Sieck GC. Impact of sarcopenia on diaphragm muscle fatigue. Exp Physiol. 2019;104(7):1090–9.
Izawa KP, Watanabe S, Oka K, Kasahara Y, Morio Y, Hiraki K, et al. Respiratory muscle strength in relation to sarcopenia in elderly cardiac patients. Aging Clin Exp Res. 2016;28(6):1143–8.
Ohara DG, Pegorari MS, Oliveira Dos Santos NL, de Fátima Ribeiro Silva C, Monteiro RL, Matos AP, et al. Respiratory Muscle Strength as a Discriminator of Sarcopenia in Community-Dwelling Elderly: A Cross-Sectional Study. J Nutr Health Aging. 2018;22(8):952–8.
Lin S-H, He Y-P, Lian J-J, Chu C-K. Procalcitonin kinetics to guide sequential invasive-noninvasive mechanical ventilation weaning in patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure: procalcitonin’s adjunct role. Libyan J Med. 2021;16(1):1961382.
Chen D, Jiang L, Li J, Tan Y, Ma M, Cao C, et al. Interaction of Acute Respiratory Failure and Acute Kidney Injury on in-Hospital Mortality of Patients with Acute Exacerbation COPD. Int J Chron Obstruct Pulmon Dis. 2021;16:3309–16.
Scarpazza P, Incorvaia C, Amboni P, di Franco G, Raschi S, Usai P, et al. Long-term survival in elderly patients with a do-not-intubate order treated with noninvasive mechanical ventilation. Int J Chron Obstruct Pulmon Dis. 2011;6:253–7.
Budweiser S, Jörres RA, Pfeifer M. Treatment of respiratory failure in COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(4):605–18.
Zhang Y, Zhang J, Ni W, Yuan X, Zhang H, Li P, et al. Sarcopenia in heart failure: a systematic review and meta-analysis. ESC Heart Fail. 2021;8(2):1007–17.
Valdiviesso R, Sousa-Santos AR, Azevedo LF, Moreira E, Amaral TF, Silva-Cardoso J, et al. Statins are associated with reduced likelihood of sarcopenia in a sample of heart failure outpatients: a cross-sectional study. BMC Cardiovasc Disord. 2022;22(1):356.
Curcio F, Testa G, Liguori I, Papillo M, Flocco V, Panicara V, et al. Sarcopenia and Heart Failure. Nutrients. 2020;12(1):211.
Okazaki T, Ebihara S, Mori T, Izumi S, Ebihara T. Association between sarcopenia and pneumonia in older people. Geriatr Gerontol Int. 2020;20(1):7–13.
Kamada T, Ohdaira H, Ito E, Takahashi J, Nakashima K, Nakaseko Y, et al. Association between masseter muscle sarcopenia and postoperative pneumonia in patients with esophageal cancer. Sci Rep. 2022;12(1):16374.
Silverio R, Gonçalves DC, Andrade MF, Seelaender M. Coronavirus Disease 2019 (COVID-19) and Nutritional Status: The Missing Link? Adv Nutr. 2021;12(3):682–92.
Kalafateli M, Mantzoukis K, Choi Yau Y, Mohammad AO, Arora S, Rodrigues S, et al. Malnutrition and sarcopenia predict post-liver transplantation outcomes independently of the Model for End-stage Liver Disease score. J Cachexia Sarcopenia Muscle. 2017;8(1):113–21.
de Sire A, Lippi L, Aprile V, Calafiore D, Folli A, D’Abrosca F, et al. Pharmacological, Nutritional, and Rehabilitative Interventions to Improve the Complex Management of Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review. J Pers Med. 2022;12(10):1626.
Acknowledgements
We thank Analisa Avila, MPH, ELS, of Liwen Bianji (Edanz) (www.liwenbianji.cn) for editing the language of a draft of this manuscript, all the patients participating in the study and all the staff involved at the hospital.
Funding
This work was supported by the National Key Research and Development Program of China (grant number: 2016YFC1304404), the Discipline Construction Project of Guangdong Medical University (grant number: 4SG21231G), the Clinical Research Project of Affiliated Hospital of Guangdong Medical University (grant numbers: LCYT2017A003, LCYJ2020B008), the Young Innovative Talents Project of Universities in Guangdong Province (grant numbers: 2018KQNCX099), the Guangdong Province Medical Research Fund Mandatory Project (grant numbers: C2019016).
Author information
Authors and Affiliations
Contributions
Dong Wu: Supervision. Xuanna Zhao and Ruoxin Su: Writing- Original draft preparation. Rongwei Hu, Yalian Yuan, Jinhong Zhang and Wenchao Zhang: Data curation. Dan Huang: Formal analysis, Validation. Yujuan Chen and Xiaoyong Xu: Visualization, Investigation. Yu Yang, Min Chen, Dongming Li and Bin Wu: Writing- Reviewing and Editing. The author(s) read and approved the final manuscript.
Corresponding authors
Ethics declarations
Ethics approval and consent to participate
The research was approved by the Ethics Committee of the Affiliated Hospital of Guangdong Medical University with the committee’s reference number 2017–879 and the registration number is NCT03187236, all participants have provided their written informed consent for study participation. The study was conducted in accordance with the Declaration of Helsinki.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
12877_2023_3784_MOESM1_ESM.docx
Additional file 1.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Zhao, X., Su, R., Hu, R. et al. Sarcopenia index as a predictor of clinical outcomes among older adult patients with acute exacerbation of chronic obstructive pulmonary disease: a cross-sectional study. BMC Geriatr 23, 89 (2023). https://doi.org/10.1186/s12877-023-03784-7
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s12877-023-03784-7
Keywords
- Sarcopenia index
- Creatinine
- Cystatin C
- Elderly patients
- Acute exacerbation of chronic obstructive pulmonary disease
- Clinical outcomes