A Correlation Analysis Between the Nutritional Status and Prognosis of COVID-19 Patients

Abstract

The high infectivity of COVID-19 has led to a rapid increase in new cases and outbreaks since December 2019 (1, 2). A part of patients showed adverse outcomes from treatment, such as severe pneumonia, pulmonary edema, acute respiratory distress syndrome (ARDS) or even multiple organ failure. Recent studies have basically identified the correlation between the poor prognosis and outcome of COVID-19 patients with their own status (3). Based on the relationship between nutritional status and prognosis, the present study fully considered the nutritional status of patients in the acute phase of admission, and chose total cholesterol, total lymphocyte and serum protein count as CONUT score to reflect their nutritional status and immunological characteristics. Since the number of studies about the epidemiological characteristics of COVID-19 is scarce, the present study aims to analyze the correlation between the nutritional status and prognosis of COVID-19 patients, and their epidemiological characteristics with different nutritional status. Methods and materials The present study used a single-center, retrospective analysis method. 489 patients who were diagnosed positive for COVID-19 in Hubei Provincial Hospital of Traditional Chinese Medicine from December 2019 to March 2020 were recruited. However, 60 patients were excluded due to their missing score of CONUT, and 429 patients were finally included in the study. The diagnostic criteria was based on Diagnosis and Treatment Protocol for COVID-19 (Trial Version 7) (4). The study was approved by the Ethics Committee of Hubei Provincial Hospital of Traditional Chinese Medicine, and the data was from the cases in our hospital during hospitalization. The average age of the included 429 patients was 58.29 ± 15.89 (The oldest: 92; the youngest: 19). The number of male patients was 212 (49.42%), and the number of female patients was 217 (50.58%). Evaluation index The demographics, medical history, signs, symptoms and inpatient lab examinations of COVID-19 patients were collected. The major indicator of adverse outcomes was the all-cause death of COVID-19 patients. Secondary indicators of adverse outcomes included transferring to ICU due to aggravation, acute heart failure or acute respiratory failure (5). The CONUT score (the highest score: 12; the lowest score: 0) of each patient was evaluated based on his/her serum albumin, peripheral blood lymphocyte count, and cholesterol concentration (6-9). CONUT score 4 was set as the critical

Approaches to Nutritional Screening in Patients with Coronavirus Disease 2019 (COVID-19)

“…Instead, in this context, it is considered a biomarker for the acute phase response that associates with the cytokine storm [ 2 , 6 ]. The situation is further complicated by variations pertaining to gender and different comorbid conditions [ 41 , 47 , 48 ]. Traditional nutritional screening measures, involving a complete nutritional examination, are only performed by qualified health professionals such as nutritionists or physicians [ 42 ].…”

“…Some of these studies also included nutritional biomarkers (e.g., total protein and albumin) [ 28 , 48 , 52 , 53 ] or anthropometric parameters such as body weight, body mass index (BMI), and calf circumference [ 34 , 48 , 50 , 51 , 52 ]. On the other hand, some studies assessed malnutrition through nutritional indices, which are calculated based on combinations of nutritional biomarkers (e.g., serum albumin and cholesterol), markers of inflammation (e.g., lymphocyte count) [ 41 , 47 , 54 ], age, comorbidities, etc. [ 43 , 48 ].…”

“…Three studies used both traditional measures and calculated indices [ 34 , 45 , 55 ]. COVID-19 related outcomes addressed in these studies included disease severity [ 34 ], COVID-19 complications (such as renal/hepatic injury [ 45 ] and muscle dystrophy [ 41 ]), admission to the ICU [ 47 ], need for oxygen therapy [ 56 ], and in-hospital mortality [ 41 , 43 , 45 , 47 , 54 , 55 ]. One study evaluated the length of hospital stay (LOS), hospital expenses, loss of appetite, and weight loss [ 34 ] while many studies evaluated the association between malnutrition and markers of inflammation [ 28 , 41 , 45 , 53 , 54 , 55 ].…”

“…In the meantime, the predictive capacity of NRS-2002 is less than that of the CONUT score and the combined CONUT-LDH-CRP (0.795%, vs. 0.813 and 0.923, respectively) in midlife and old COVID-19 patients (mean age = 58 years, range = 41–70 years) [ 45 ]. Moreover, higher CONUT scores correlate with age [ 41 , 45 , 55 ]—COVID-19 patients ≥61 years old with high CONUT score exhibit a 6.2-fold higher risk for adverse outcomes compared with counterparts with low CONUT score (relative risk = 6.191, 95% CI: 1.431–26.785) [ 47 ]. According to Table 1 , the majority of COVID-19 patients in most studies were elderly adults.…”

“…It is worth mentioning that the cutoff points of the CONUT score were inconsistently defined in some studies. In one study, a group of moderate-severe cases was defined based on a CONUT score > 5 [ 41 ], while another study identified high malnutrition by a CONUT score of 5–12 [ 47 ]. In a third study, severe malnutrition was based on a CONUT score > 9 [ 54 ].…”