Effect of Modified Shenling Baizhu Powder on Readmission Rates and Hospital Stay in Stable Chronic Obstructive Pulmonary Disease with Secondary Sarcopenia: A Retrospective Cohort Study with Network Pharmacology and Mechanistic Analysis.

INTRODUCTION: Integrated therapeutic strategies for Chronic Obstructive Pulmonary Disease (COPD) combined with sarcopenia remain limited. This study evaluated the effect of Modified Shenling Baizhu Powder (MSBP) on readmission rates in stable COPD patients with secondary sarcopenia and explored its potential mechanisms. METHODS: In this retrospective cohort study with propensity score matching (1:1), 131 patients received MSBP combined with Western medicine (exposure group), and 114 received Western medicine alone (control group). Primary outcomes were the 1-year readmission rate and interval. Mechanisms were explored via network pharmacology, transcriptomics, ultra-performance liquid chromatography-mass spectrometry (UPLC-MS), and molecular docking. RESULTS: The readmission rate was significantly lower in the exposure group than in the control group (24.4% vs. 43.9%, p < 0.05), with a longer median readmission interval (319 vs. 272 days, p < 0.05). MSBP was an independent protective factor (OR = 0.202, p < 0.05). Network pharmacology and transcriptomics identified the PI3K/AKT pathway as a key mechanism. UPLC-MS identified five flavonoid components; kaempferol-3- O-rutinoside showed strong binding affinity to PI3K/AKT proteins in docking studies. DISCUSSION: MSBP combined with Western medicine effectively reduces hospital readmissions in this population. The therapeutic mechanism likely involves PI3K/AKT pathway activation by flavonoid components, particularly kaempferol-3-O-rutinoside. CONCLUSION: MSBP offers clinical benefits for COPD with secondary sarcopenia. The PI3K/AKT pathway and specific flavonoids represent potential mechanistic targets warranting further investigation.