Low FFMI according to ESPEN cut-offs is a strong independent predictor of mortality in patients with COPD

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Introduction: Low fat free mass index (FFMI) is a component of the ESPEN diagnosis criteria of malnutrition, and when accompanied with weight loss is considered to be a determinant of malnutrition. FFMI alone was found to predict mortality in chronic obstructive pulmonary disease (COPD) in previous studies. Our aim was to assess independent effect of low FFMI according to the ESPEN criteria cut-offs on mortality of COPD patients. Methods: Subjects of the study were COPD patients assessed for nutritional status from 2015 to 2017 in our institution. Body composition was measured by bioelectrical impedance analysis. Low fat-free mass index (FFMI) was defined as <17 kg.m−2 for males and < 15 kg.m−2 for females according to ESPEN criteria. Medical records were reviewed, and vital status was obtained from Central Population Registry. Results: We identified 221 patients (age 66±8y, men 57%, FEV1 39±18% predicted, BMI 24±7 kg/m2). Low FFMI was present in 59% of patients. During median follow-up of 376 days (IQR 182-686 days), 51 (23%) patients died. More patients with low FFMI died (34.4% vs 6.7%, p<0.001). In a multivariate Cox proportional hazard model, adjusted for age, BMI, FEV1 % predicted, gender and low FFMI, only FEV1 (HR 0.97, 95% CI 0.94-0.99) and low FFMI (HR 5.2, 95% CI 1.1-24.4) remained predictive of mortality. Conclusion: Low FFMI according to the ESPEN criteria was present in 59% of patients with COPD. The risk of mortality was 5-fold in patients with low FFMI compared to normal FFMI, independent of BMI or spirometric severity of COPD. Low FFMI when using ESPEN criteria cut-offs is a very strog predictor of mortality in COPD patients.

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