Assessing the Impact of Nutrition Status as a Prognostic Factor in the Outcome of NIV therapy in Patients of Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD), a progressive and irreversible lung condition, poses a significant global health burden, especially due to acute exacerbations (AECOPD). A crucial technique for treating AECOPD, reducing the need for invasive mechanical ventilation, and enhancing patient outcomes is non-invasive ventilation (NIV). However, malnutrition, common in COPD patients, can affect the success of NIV. This study highlights the influence of nutritional status (BMI) on the outcome of NIV in AECOPD patients.
Methods: Patients with severe AECOPD and respiratory acidosis who were admitted to the Respiratory Medicine Department’s High Dependency Unit (HDU) and receiving NIV were subjects of the current cross-sectional and observation study. The sample size of the study population was 71. Patients were categorized on the basis of body mass index (BMI) into various groups, along with their clinical outcomes, (SpO2, pH, pCO2, and HCO3- levels at t0, 24, 48, and 72 hours) as well as the duration of hospital stay (days) were recorded after NIV application. Statistical analysis was performed to determine associations between BMI and clinical outcomes.
Results: The study population exhibited a mean age of 63.10 years, with 68.6% males. Significant improvements in SpO2, pH, PaCO2 and HCO3- levels were observed across all BMI groups. The greatest SpO2 changes were seen at discharge, with 57.3% in underweight, 57.8% in normal weight, 33.1% in overweight, and 67.8% in obesity. The normal weight group showed the most rapid and consistent pH and HCO3- improvements (max. 2.1 and -28.1%, respectively), while PaCO2 decreased the most in normal weight (-45.6%). BMI didn’t significantly influence the duration of hospital stay (p = 0.387).
Conclusion: Nutritional status, as assessed by BMI, influences the clinical outcomes in AECOPD patients undergoing NIV, showed significant improvements in SpO2, pH, PaCO2, and HCO3- levels across all BMI groups suggested that NIV therapy was effective regardless of BMI. The normal weight and underweight groups exhibited the fastest improvements, while the overweight and obesity groups showed delayed but substantial changes by discharge. Despite these differences, BMI did not significantly influence the overall SpO2 trajectory (p >0.005) and the duration of hospital stay (p = 0.387).