Muscle loss contributes to higher mortality, cost in COPD

Patients with chronic obstructive pulmonary disease (COPD) exacerbations and a muscle loss phenotype are at greater risk of in-hospital mortality, have longer length of stay (LOS), and higher healthcare costs, a recent study has found.

The investigators sought to determine whether patients hospitalized for COPD exacerbation with versus without a secondary diagnosis of muscle loss phenotype (all ICD-9 codes associated with muscle loss including cachexia) would have higher mortality and cost of care.

They used the NIS database to identify hospitalized patients in the US from 1 January to 31 December 2011 and to analyse the impact of a muscle loss phenotype on in-hospital mortality, LOS, and healthcare cost for each of the 174,808 hospitalizations for COPD exacerbations.

A secondary diagnosis of muscle loss phenotype was found in 12,977 (7.4 percent) patients admitted for a COPD exacerbation. A diagnosis of muscle loss phenotype correlated with a markedly higher in-hospital mortality (14.6 percent vs 5.7 percent; p<0.001), LOS (13.3+17.1 vs 5.7+7.6; p<0.001), and median hospital charge per patient ($13,947 vs $6,610; p<0.001).

On multivariate regression analysis, muscle loss phenotype increased mortality by 111 percent (95 percent confidence interval, 2.0–2.2; p<0.001), LOS by 68.4 percent (p<0.001), and the direct cost of care by 83.7 percent (p<0.001) compared to those without muscle loss.

“COPD is the third most common cause of death worldwide and fourth most common in the US,” the investigators said. “In hospitalized patients with COPD, mortality, morbidity, and healthcare resource utilization are high.”