title: Economic and operational burden associated with malnutrition in chronic obstructive pulmonary disease.
abstract: Malnutrition is common in patients with chronic obstructive pulmonary disease (COPD). This study aimed to explore its association with all-cause mortality, emergency hospitalisation and subsequently healthcare costs.
  
  
  
  A prospective cohort observational pilot study was carried out in outpatients with COPD that attended routine respiratory clinics at a large tertiary Australian hospital during 2011. Electronic hospital records and hospital coding was used to determine nutritional status and whether a patient was coded as nourished or malnourished and information on healthcare use and 1-year mortality was recorded.
  
  
  
  Eight hundred and thirty four patients with COPD attended clinics during 2011, of those 286 went on to be hospitalised during the 12 month follow-up period. Malnourished patients had a significantly higher 1-year mortality (27.7% vs. 12.1%; p = 0.001) and were hospitalised more frequently (1.11 SD 1.24 vs. 1.51 SD 1.43; p = 0.051). Only malnutrition (OR 0.36 95% CI 0.14-0.91; p = 0.032) and emergency hospitalisation rate (OR 1.58 95% CI 1.2-2.1; p = 0.001) were independently associated with 1-year mortality. Length of hospital stay was almost twice the duration in those coded for malnutrition (11.57 SD 10.93 days vs. 6.67 SD 10.2 days; p = 0.003) and at almost double the cost (AUD $23,652 SD $26,472 vs. $12,362 SD $21,865; p = 0.002) than those who were well-nourished.
  
  
  
  Malnutrition is an independent predictor of 1-year mortality and healthcare use in patients with COPD. Malnourished patients with COPD present both an economic and operational burden.
authors: School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4059, Australia; Department of Dietetics and Nutrition, Ng Teng Fong General Hospital, Jurong Health Services, 609606, Singapore.
authors: Jian Ming
authors: JM
authors: Hoong
authors: Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, 4102, Australia.
authors: Maree
authors: M
authors: Ferguson
authors: Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, QLD, 4102, Australia.
authors: Craig
authors: C
authors: Hukins
authors: School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4059, Australia; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, 4102, Australia. Electronic address: pf.collins@qut.edu.au.
authors: Peter F
authors: PF
authors: Collins
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000191:economics; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000191:economics / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D009026:Mortality; D015596:Nutrition Assessment; D009752:Nutritional Status; D010865:Pilot Projects; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000191:economics / Q000401:mortality / Q000628:therapy; D011788:Quality of Life; D011793:Queensland / Q000453:epidemiology; D016019:Survival Analysis; D062606:Tertiary Care Centers
keywords: COPD; Chronic obstructive pulmonary disease; Cost analysis; Healthcare use; Malnutrition; Mortality