Evaluation of the Relationship between Nutritional Status of COVID-19 Patients Admitted to the ICU and Patients’ Prognosis: A Cohort Study

Abstract

Background. Malnutrition in COVID-19 critically ill patients can lead to poor prognosis. This study aimed to evaluate the association between nutritional status (or risk) and the prognosis of critically ill COVID-19 patients. In this study, prognosis is the primary outcome of “hospital mortality” patients. The second outcome is defined as “need for mechanical ventilation.” Methods and Materials. In this single-center prospective cohort study, 110 patients admitted to the Intensive Care Unit of Imam Khomeini Hospital Complex (Tehran, Iran) between April and September 2021 were enrolled. Participants formed a consecutive sample. MNA-SF, NRS-2002, mNUTRIC, and PNI scores were used to evaluate nutritional assessment. Patients’ lab results and pulse oximetric saturation SpO2/FiO2 (SF) ratio at the time of intensive care unit (ICU) admission were collected. Patients were screened for nutritional status and categorized into two groups, patients at nutritional risk and nonrisk. Results. Sixty-five (59.1%) of all patients were men. The overall range of age was 52 ± 15. Thirty-six (32.7%) of patients were obese (BMI ≥ 30). The hospital mortality rate was 59.1% (n = 65). According to the different criteria, malnutrition rate was 67.3% (n = 74) (NRS), 28.2% (n = 31) (MNA), 34.5% (n = 38) (mNUTRIC), and 58.2% (n = 64) (PNI). There was a statistically significant association between chronic kidney disease (CKD) and mNUTRIC risk (OR = 13.5, 95% CI (1.89–16.05), P = 0.002 ), diabetes mellitus (DM) and MNA risk (OR = 2.82, 95% CI (1.01–7.83), P = 0.041 ), hypertension (HTN) and MNA risk (OR = 5.63, 95% CI (2.26–14.05), P < 0.001 ), and malignancy and mNUTRIC risk ( P = 0.048 ). The nutritional risk (all tools) significantly increased the odds of in-hospital death and need for mechanical ventilation. The length of stay was not significantly different in malnourished patients. Conclusion. In the critical care setting of COVID-19 patients, malnutrition is prevalent. Malnutrition (nutritional risk) is associated with an increased risk of need for mechanical ventilation and in-hospital mortality. Patients with a history of HTN, CKD, DM, and cancer are more likely to be at nutritional risk at the time of ICU admission.

Alignment of Global Leadership Initiative on Malnutrition (GLIM) and Mini Nutritional Assessment (MNA) in the evaluation of nutritional status and its association with clinical outcomes of hospitalized COVID-19 patients

“…Additionally, Rouget and colleagues calculated a high rate of malnutrition (37.5%) in patients with COVID-19 in their study, and based on this data, it was determined that nutritional support is essential in COVID-19 care 29 . Mohammadi and colleagues found that nutritional status is of particular importance in hospitalized patients with COVID-19, and malnutrition can lead to longer hospitalization periods and even increased mortality in these patients 30 .…”

The role of nutritional risk evaluation in predicting adverse outcomes among patients with severe COVID-19 in Vietnam

“…NRS is also considered the first screening tool for malnutrition among patients with COVID-19 in several international guidelines ( 8 ), and a score ≥ 3 is related to a higher mortality risk ( 27 ). The percentage of undernutrition determined by the NRS tool ranged from 61.5 to 67.3% among COVID-19 patients admitted to ICU ( 7 , 28 ).…”

“…We used the sample size formula for estimating a proportion. Data from a previous study showed that 67.3% of patients admitted to the ICU had malnutrition using the Nutritional Risk Screening scale ( 7 ). Z of ( for a 95% confidence interval was 1.96, ε = 0.1: Thus, the calculated sample size was 154 patients.…”

“…Previous studies showed that undernutrition has been recognized as an underlying mortality risk factor among COVID-19 patients ( 6 , 7 ). Thus, nutrition risk screening is recommended as a compulsory examination for COVID-19 patients at hospital admission.…”

Fungal Infections in the ICU during the COVID-19 Era: Descriptive and Comparative Analysis of 178 Patients

“…Hypoalbuminemia could represent a subtle indicator of malnourishment. The nutritional status of patients has been a concern in the literature, as a high percentage of ICU COVID-19 patients seems to be at severe risk of malnourishment, and early studies have shown a correlation with increased length of ICU stay and mortality [ 21 , 22 , 23 ]. Unfortunately, no further data are available in our study to support such a correlation with fungal infections, and only a hypothesis to be tested in a future study can be made.…”