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Background <p>Muscle dysfunction and malnutrition are common systemic manifestations of chronic obstructive pulmonary disease (COPD) and may influence ventilatory support needs. We evaluated the association between pectoralis muscle area (PMA) and the Prognostic Nutritional Index (PNI) and the prescription of home non-invasive ventilation (NIV) in patients hospitalized for acute hypercapnic COPD exacerbations.</p> Methods <p>In this retrospective study, hypercapnic COPD patients hospitalized between 2016 and 2023 were included. PMA was measured on thoracic computed tomography at the T4 level, and PNI was calculated from serum albumin and lymphocyte count. Patients were classified as chronic NIV users (Group I), acute users discharged with NIV (Group II), and acute users discharged without NIV (Group III). Logistic regression identified independent predictors of new home NIV prescription.</p> Results <p>Among 796 patients (mean age 71.1 ± 12&#xa0;years; 65.7% male), mean PNI was low (33.9 ± 7.3) and similar across groups. In univariate analysis, younger age, higher PaCO₂, respiratory acidosis, greater PMA, mechanical ventilation, and ICU admission were associated with NIV prescription (p &lt; 0.05). In multivariate analysis, higher PaCO₂ (OR 1.041; 95% CI 1.021–1.061; p &lt; 0.001) and greater PMA (OR 1.299; 95% CI 1.063–1.587; p = 0.01) remained independent predictors, while younger age showed a modest association (OR 0.981; p = 0.038). PNI was not independently associated.</p> Conclusion <p>Home NIV prescription in acute hypercapnic COPD exacerbations appears to reflect physiological severity, particularly hypercapnia, and functional reserve as indicated by PMA, rather than nutritional status alone.</p>

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The effect of pectoralis muscle area and nutritional index on the need for NIV treatment in COPD patients with acute respiratory failure

  • 期刊论文

  • 发表日期：

    2026年4月16日

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  • Ayşe Çapar,
  • Yahya Baraç,
  • Şeyma Başlılar

摘要

Background

Muscle dysfunction and malnutrition are common systemic manifestations of chronic obstructive pulmonary disease (COPD) and may influence ventilatory support needs. We evaluated the association between pectoralis muscle area (PMA) and the Prognostic Nutritional Index (PNI) and the prescription of home non-invasive ventilation (NIV) in patients hospitalized for acute hypercapnic COPD exacerbations.

Methods

In this retrospective study, hypercapnic COPD patients hospitalized between 2016 and 2023 were included. PMA was measured on thoracic computed tomography at the T4 level, and PNI was calculated from serum albumin and lymphocyte count. Patients were classified as chronic NIV users (Group I), acute users discharged with NIV (Group II), and acute users discharged without NIV (Group III). Logistic regression identified independent predictors of new home NIV prescription.

Results

Among 796 patients (mean age 71.1 ± 12 years; 65.7% male), mean PNI was low (33.9 ± 7.3) and similar across groups. In univariate analysis, younger age, higher PaCO₂, respiratory acidosis, greater PMA, mechanical ventilation, and ICU admission were associated with NIV prescription (p < 0.05). In multivariate analysis, higher PaCO₂ (OR 1.041; 95% CI 1.021–1.061; p < 0.001) and greater PMA (OR 1.299; 95% CI 1.063–1.587; p = 0.01) remained independent predictors, while younger age showed a modest association (OR 0.981; p = 0.038). PNI was not independently associated.

Conclusion

Home NIV prescription in acute hypercapnic COPD exacerbations appears to reflect physiological severity, particularly hypercapnia, and functional reserve as indicated by PMA, rather than nutritional status alone.