{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:59:44Z","timestamp":1781006384767,"version":"3.54.1"},"reference-count":31,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Nutritional impairment and systemic inflammation contribute to disease progression and poor outcomes in Chronic Obstructive Pulmonary Disease (COPD). The geriatric-nutritional-risk-index (GNRI) and prognostic-nutritional-index (PNI) are practical markers reflecting both nutritional and immune status. In elderly COPD patients, malnutrition-related exacerbations often worsen quality of life and increase hospitalization. Identifying reliable predictors of exacerbation risk is therefore important for improving disease management. This study evaluated the association between GNRI, PNI and exacerbation frequency across different age groups in COPD. Materials and Methods: This multicenter retrospective study included 302 patients with COPD from 10 medical centers. All patients were classified as GOLD Group-E according to exacerbation history. Demographic characteristics, pulmonary function tests, Charlson-Comorbidity-Index (CCI), pharmacological treatments, dyspnea scores, and annual exacerbation frequency were obtained from hospital databases. Laboratory parameters including complete blood count, C-reactive protein, albumin, and total protein were recorded. GNRI, PNI, and neutrophil-to-lymphocyte ratio (NLR) were calculated to evaluate nutritional and inflammatory status. Results: The mean age of participants was 67.9 \u00b1 9.6 years and 26.5% were female. Elderly patients had significantly higher CCI scores, longer disease duration, greater cumulative smoking exposure, and more frequent exacerbations than younger patients (p &lt; 0.001). Pulmonary function parameters were significantly lower in the elderly group, while long-term oxygen therapy and nebulizer use were more common (p &lt; 0.001). Baseline and exacerbation NLR levels were higher in elderly patients, whereas GNRI and PNI values were lower during both stable disease and exacerbation periods. Patients with more than four exacerbations per year had significantly higher NLR and lower GNRI values. Conclusions: Elderly COPD patients in GOLD Group-E demonstrate marked inflammatory and nutritional burden. Lower PNI values were independently associated with increased annual exacerbation frequency, while lower GNRI values were observed in patients with greater inflammatory and nutritional burden. Routine immune-nutritional assessment may improve risk stratification and help identify patients who could benefit from early multidisciplinary management.<\/jats:p>","DOI":"10.3390\/medicina62061121","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T09:46:54Z","timestamp":1780998414000},"page":"1121","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Frequency of Exacerbations in Patients with COPD and Their Nutritional Status: A Multicenter Study"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4274-0333","authenticated-orcid":false,"given":"Ceren","family":"Degirmenci","sequence":"first","affiliation":[{"name":"Department of Chest Diseases, Mugla Training and Research Hospital, 48000 Mugla, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maide Gozde","family":"Inam","sequence":"additional","affiliation":[{"name":"Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1499-3747","authenticated-orcid":false,"given":"Ozge","family":"Oral Tapan","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Faculty of Medicine, Training and Research Hospital, Mugla Sitki Kocman University, 48000 Mugla, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5750-1223","authenticated-orcid":false,"given":"Aytekin","family":"Idikut","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Bartin State Hospital, 74100 Bart\u0131n, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silam","family":"Yesilyurt","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Sincan Training and Research Hospital, 06949 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatih","family":"Tekin","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Van Training and Research Hospital, 65300 Van, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serife Nur","family":"Ozturk","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Gaziantep City Hospital, 27470 Gaziantep, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muge","family":"Gencer Tuluy","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Izmir Buca Seyfi Demirsoy Training and Research Hospital, 35390 \u0130zmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugur","family":"Fidan","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Batman Kozluk State Hospital, 72400 Batman, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyma","family":"Tunc","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Kastamonu Training and Research Hospital, 37150 Kastamonu, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9077-0580","authenticated-orcid":false,"given":"Nazli","family":"Cetin","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Afyonkarahisar State Hospital, 03030 Afyonkarahisar, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5241-4043","authenticated-orcid":false,"given":"Neslihan","family":"Kose Kabil","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Faculty of Medicine, Yalova University, 77200 Yalova, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3778-0077","authenticated-orcid":false,"given":"Zeynep","family":"Yilmaz Kaya","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Gaziantep City Hospital, 27470 Gaziantep, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.5588\/ijtld.19.0397","article-title":"The GOLD Summit on chronic obstructive pulmonary disease in low- and middle-income countries","volume":"23","author":"Halpin","year":"2019","journal-title":"Int. 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