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This research aims to determine which nutritional assessment tool best predicts all-cause mortality in stable COPD patients in outpatient settings.

April 19, 2026Open Access

Comparison of Tools for Nutrition Assessment in Stable Subjects with Chronic Obstructive Pulmonary Disease: Which is the Best Mortality Predictor in Real Clinical Practice?

Key Points

This research aims to determine which nutritional assessment tool best predicts all-cause mortality in stable COPD patients in outpatient settings.
Secondary analysis of a prospective, hospital-based observational cohort.
Involves 141 outpatients with stable COPD.
Nutritional status assessed using BMI, %IBW, GNRI, PNI, and CONUT.
Cox proportional hazards models used to analyze mortality associations.
Multivariate analyses adjusted for age, GOLD stage, and CAT score.
29 deaths (20.6%) occurred during the follow-up period.
Malnutrition prevalence varied from 7.8% (PNI < 45) to 25.5% (CONUT ≥ 2).
Only PNI < 45 significantly associated with mortality (adjusted hazard ratio 3.85).
PNI provided the best AIC among the five nutritional tools.
Significantly poorer survival observed in the low PNI group (log-rank p < 0.001).

Abstract

Koichi Nishimura,1,2 Masaaki Kusunose,3 Ayumi Shibayama,4 Kazuhito Nakayasu5 1National Center for Geriatrics and Gerontology, Obu, Aichi, Japan; 2Clinic Nishimura, Ayabe, Kyoto, Japan; 3Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan; 4Department of Nursing, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan; 5Data Research Section, Kondo Inc, Osaka, Osaka, JapanCorrespondence: Koichi Nishimura, Clinic Nishimura, 4-3. Kohigashi, Kuri-cho, Ayabe, Kyoto, 623-0222, Japan, Tel +81-773-47-0321, Fax +81-773-47-0201, Email koichinishimura1@gmail.comPurpose: Malnutrition is associated with poor outcomes in chronic obstructive pulmonary disease (COPD), but the prognostic value of different nutritional assessment tools in outpatient settings remains unclear. We aimed to identify which of five commonly used nutritional indicators best predicts all-cause mortality in stable COPD in real-world clinical practice.Patients and Methods: This secondary analysis of a prospective, hospital-based observational cohort included 141 outpatients with stable COPD. Nutritional status was assessed using body mass index (BMI), percent ideal body weight (%IBW), geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and controlling nutritional status (CONUT) score. Patients were categorized as malnourished or well-nourished according to established cut-off values, including PNI < 45 as a widely used threshold for malnutrition. Associations with all-cause mortality over a median follow-up of 54 months were examined using Cox proportional hazards models. Multivariate analyses adjusted for age, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, and COPD Assessment Test (CAT) score, and model fit was compared using Akaikeâs Information Criterion (AIC).Results: During follow-up, 29 deaths (20.6%) occurred. The proportion classified as malnourished ranged from 7.8% (PNI < 45) to 25.5% (CONUT â¥ 2). In multivariate analyses, only PNI < 45 remained significantly associated with mortality (adjusted hazard ratio 3.85; 95% confidence interval 1.33â 11.13; p = 0.013) and provided the best AIC among the five tools. KaplanâMeier curves demonstrated significantly poorer survival in the low PNI group (log-rank p < 0.001).Conclusion: Among five simple nutritional assessment tools, only PNI independently predicted long-term mortality in stable COPD. Given its simplicity, objectivity, and reliance on routinely available laboratory parameters, PNI appears to be a practical marker to support risk stratification and guide proactive management in outpatient COPD care.Keywords: chronic obstructive pulmonary disease, nutrition assessment, mortality, body mass index, ideal body weight

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