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Midthigh Muscle Cross-Sectional Area Is a Better Predictor of Mortality than Body Mass Index in Patients with Chronic Obstructive Pulmonary Disease

Centre de recherche, Hôpital Laval, Institut Universtaire de Cardiologie et de Pneumologie de L'Université Laval, Québec, Canada

Correspondence and requests for reprints should be addressed to Dr. François Maltais, Centre de Pneumologie, Hôpital Laval, 2725 Chemin Ste-Foy, Ste-Foy, PQ, G1V 4G5 Canada. E-mail: medfma{at}hermes.ulaval.ca

This study was undertaken to test the hypothesis that a reduction in midthigh muscle cross-sectional area obtained by CT scan (MTCSA_CT) is a better predictor of mortality in chronic obstructive pulmonary disease (COPD) than low body mass index (BMI). We also wished to evaluate whether anthropometric measurements could be used to estimate MTCSA_CT. One hundred forty-two patients with COPD (age = 65 ± 9 years, mean ± SD, 26 F, BMI = 26 ± 6 kg/m², FEV₁ = 42 ± 16% predicted) were recruited from September 1995 to April 2000 with a mean follow-up of 41 ± 18 months. The primary end-point was all-cause mortality during the study period. A Cox proportional hazards regression model was used to predict mortality using the following independent variables: age, sex, daily use of corticosteroid, FEV₁, DL_CO, BMI, thigh circumference, MTCSA_CT, peak exercise workrate, Pa_O2, and Pa_CO2. Only MTCSA_CT and FEV₁ were found to be significant predictors of mortality (p = 0.0008 and p = 0.01, respectively). A second analysis was also performed with FEV₁ and MTCSA_CT dichotomized. Patients were divided into four subgroups based on FEV₁ (< or 50% predicted) and MTCSA_CT (< or 70 cm²). Compared with patients with an FEV₁ 50% predicted and a MTCSA_CT 70 cm², those with an FEV₁ < 50% predicted and a MTCSA_CT 70 cm² had a mortality odds ratio of 3.37 (95% confidence interval, 0.41–28.00), whereas patients with an FEV₁ < 50% predicted and a MTCSA_CT < 70 cm² had a mortality odds ratio of 13.16 (95% confidence interval, 1.74–99.20). MTCSA_CT could not be estimated with sufficient accuracy from anthropometric measurements. In summary, we found in this cohort of patients with COPD that (1) MTCSA_CT was a better predictor of mortality than BMI, and (2) MTCSA had a strong impact on mortality in patients with an FEV₁ < 50% predicted. These findings suggest that the assessment of body composition may be useful in the clinical evaluation of these patients.

Key Words: chronic obstructive pulmonary disease • muscle • survival • body weight • wasting

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