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Key Clinical Message: Stone heart syndrome has a complex interaction with digoxin toxicity, where, theoretically, the administration of intravenous calcium can worsen a patient's condition. Research on this subject is conflicting, so it is imperative to approach it cautiously. [ABSTRACT FROM AUTHOR]

Background: The obesity paradox suggests that obese patients with Chronic Obstructive Pulmonary Disease Exacerbation (COPDE) may have better outcomes. COPD patients are at a higher risk of becoming malnourished, which has been linked to poor outcomes., Objective: This paper aims to study the impact of malnutrition in patients with and without obesity hospitalized with COPDE., Methods: Our retrospective study analyzed data from the National Inpatient Sample dataset between 2017 and 2020 to observe patients who were hospitalized with COPDE. The patients were divided into two groups: with and without malnutrition. The outcomes included all-cause mortality, invasive mechanical ventilation, length of stay, and total charge. We adjusted for confounders using multivariate regression model analysis., Results: The study involved 392,920 patients with COPDE, out of which 5720 (1.45%) were diagnosed with malnutrition. Most of the patients in both groups were female, white, and under Medicare coverage. The mean age was higher in patients with malnutrition (67.6 vs . 64 years). In both groups, the rates of admissions were lowest in 2020 compared to three years prior. The rates and adjusted odds ratios of all-cause mortality were higher in patients with malnutrition (3.59% vs . 0.61%, P <0.01; adjusted odds ratio (aOR) 2.36, P<0.01, CI 1.8-3.7). We observed comparable findings when using invasive mechanical ventilation (13.2% vs . 2.82%, P<0.01, aOR 4.9, P<0.01, 3.9-6). Malnourished patients had a lengthier hospital stay and a greater total charge., Conclusion: Malnutrition was identified as an independent risk factor associated with worse outcomes in obese patients admitted with COPD exacerbation., Competing Interests: Dr. Salim Surani is the Co-Editor of The Open Respiratory Medicine Journal., (© 2024 The Author(s). Published by Bentham Open.)