Nutritional and Functional Impact of Acute SARS-CoV-2 Infection in Hospitalized Patients

Gómez-Uranga, Angie; Guzmán-Martínez, Javier; Esteve-Atiénzar, Pedro Jesús; Wikman-Jorgensen, Philip; Núñez-Cruz, Juan Manuel; Espinosa-del-Barrio, Leticia; Hernández-Isasi, Isidro; Pomares, Francisco; Camacho, Eva Perelló; Fernández-García, Nuria; Sánchez-Miralles, Ángel; Giner-Galvañ, Vicente

doi:10.3390/jcm11092424

Cited by 11 publications

(7 citation statements)

References 32 publications

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“…In older patients with COVID-19, rather than disease severity, the effect of prolonged immobilization due to extended hospital stay, reduced nutritional intake, and isolation could further trigger the occurrence of new disability. Notably, patients losing ADL had a significantly more extended hospital stay than their counterparts, in agreement with a recent study by Gómez-Uranga et al [ 9 ], demonstrating how frailty is related to longer hospitalization for COVID-19, harming nutritional and functional status following hospital discharge. Accordingly, in the present study, we observed the presence of a persistent functional disability in one-fifth of patients following hospital discharge, thus underlying the possibility of including the functional loss in the definition of the Long COVID symptoms in older adults.…”

Section: Discussionsupporting

confidence: 90%

“…Indeed, loss of autonomy in basic activities, known as activities of daily living (ADL), is strongly associated with institutionalization and death [ 8 ]. In this setting, a recent study showed that hospitalization for acute SARS-CoV-2 infection harmed older patients’ functional autonomy, especially in those with severe disease and more impaired basal ADLs [ 9 ]. Nonetheless, albeit even the loss of a single ADL function is associated with an increased likelihood of requiring long-term nursing care [ 10 ] and poor outcomes [ 11 ], far too little attention has been devoted to the loss of functionality after hospitalization for COVID-19.…”

Section: Introductionmentioning

confidence: 99%

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Determinants of Cause-Specific Mortality and Loss of Independence in Older Patients following Hospitalization for COVID-19: The GeroCovid Outcomes Study

Okoye

Calsolaro

Calabrese

et al. 2022

JCM

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Hospitalization for acute SARS-CoV-2 infection confers an almost five-fold higher risk of post-discharge, all-cause mortality compared to controls from the general population. A negative impact on the functional autonomy of older patients, especially in cases of severe disease and prolonged hospitalization, has been recently described. However, little is known about the determinants of cause-specific mortality and loss of independence (LOI) in the activities of daily living (ADL) following COVID-19 hospitalization. Thus, the current prospective, multicenter study is aimed at identifying the determinants of post-discharge cause-specific mortality and the loss of autonomy in at least one ADL function. Older patients hospitalized for a SARS-CoV-2 infection were consecutively enrolled in an e-Registry from 1 March 2020, until 31 December 2020. After at least six months from discharge, patients were extensively re-evaluated according to a common protocol at the outpatient clinic of eight tertiary care Italian hospitals. Oof 193 patients [109 (56.4%) men, mean age 79.9 ± 9.1 years], 43 (22.3%) died during follow-up. The most common causes of death were cardiovascular diseases (46.0%), respiratory failure (26.5%), and gastrointestinal and genitourinary diseases (8.8% each). Pre-morbid ADLs qualified as an independent mortality risk factor [adjusted HR 0.77 (95%CI: 0.63–0.95)]. Of 132 patients, 28 (21.2%) lost their independence in at least one ADL. The adjusted risk of LOI declined with a lower frailty degree [aOR 0.03 (95%CI: 0.01–0.32)]. In conclusion, at long-term follow-up after hospitalization for acute SARS-CoV-2 infection, more than 40% of older patients died or experienced a loss of functional independence compared to their pre-morbid condition. Given its high prevalence, the loss of functional independence after hospitalization for COVID-19 could be reasonably included among the features of the “Long COVID-19 syndrome” of older patients.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Determinants of Cause-Specific Mortality and Loss of Independence in Older Patients following Hospitalization for COVID-19: The GeroCovid Outcomes Study

Okoye

Calsolaro

Calabrese

et al. 2022

JCM

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“…Confirming previous studies [ 25 ], malnutrition as defined using the GLIM definition [ 18 , 19 ], was present in many of our patients and people registered in GIR 1 are more affected by the risk of malnutrition [ 26 ], and in a study investigating 4520 residents, residents who were malnourished showed an increase in overall dependency, including during mealtimes and while walking, which are major activities of daily living [ 27 ]. This reinforces the link between malnutrition and a patient’s functional status, including frailty and dependency [ 28 , 29 , 30 ].…”

Section: Discussionsupporting

confidence: 55%

Effects of Rehabilitation on Long-COVID-19 Patient’s Autonomy, Symptoms and Nutritional Observance

et al. 2022

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Background: Despite significant improvements in COVID-19 therapy, many patients still present with persistent symptoms and quality-of-life alterations. The aim of this study was to simultaneously investigate the long-term evolution of autonomy, malnutrition and long-lasting symptoms in people infected with COVID-19 and hospitalized in the ICU. Method: Patients’ clinical characteristics; extent of their loss of autonomy based on “Autonomie Gérontologie Groupes Iso-Ressources” (AG-GIR) classification; nutritional status while following the French and Global Leadership Initiative on Malnutrition (GLIM) recommendations; and symptom evolutions before infection, during hospitalization and rehabilitation, and up to 6 months after returning home were determined in thirty-seven patients. Results: Prior to a COVID-19 infection, all patients were autonomous, but upon admission to the rehabilitation center (CRM), 39% of them became highly dependent. After discharge from the center and 6 months after returning home, only 6 and 3%, respectively, still required considerable assistance. Of these thirty-seven patients, 11% were moderately malnourished and 81% presented with severe malnutrition, with a significant correlation being observed between malnutrition and autonomy (p < 0.05). Except for fatigue, which persisted in 70% of the patients 6 months after discharge from rehabilitation, all other symptoms decreased significantly. Conclusions: This study shows a striking decrease in autonomy associated with malnutrition after hospitalization for a COVID-19 infection and a clear beneficial effect from personalized rehabilitation. However, although almost all patients regained autonomy 6 months after returning home, they often still suffer from fatigue. Patient compliance with their nutritional recommendations deserves further improvement, preferably through personalized and persistent follow-up with the patient.

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“…An analysis of the disease as such takes into account not only the infectious variables but also the social and nutritional variables and comorbidities, revealing biological and social interactions that are important for prognosis, treatment, and health policy [ 13 , 40 , 41 , 42 ]. Albumin could be a good prognostic marker because it is a global indicator of individual susceptibility, bringing together the influence of comorbidities, anti-inflammatory reactions to infection, markers of systemic inflammation [ 10 , 11 , 12 ], and nutritional status [ 54 ]. Thus, SA could explain the association between comorbidity, one of the most important determinants of the course of COVID-19, and poor prognosis [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

C-Reactive Protein and Serum Albumin Ratio: A Feasible Prognostic Marker in Hospitalized Patients with COVID-19

et al. 2022

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(1) Background: C-reactive protein (CRP) and albumin are inflammatory markers. We analyzed the prognostic capacity of serum albumin (SA) and CRP for an outcome comprising mortality, length of stay, ICU admission, and non-invasive mechanical ventilation in hospitalized COVID-19 patients. (2) Methods: We conducted a retrospective cohort study based on the Spanish national SEMI-COVID-19 Registry. Two multivariate logistic models were adjusted for SA, CRP, and their combination. Training and testing samples were used to validate the models. (3) Results: The outcome was present in 41.1% of the 3471 participants, who had lower SA (mean [SD], 3.5 [0.6] g/dL vs. 3.8 [0.5] g/dL; p < 0.001) and higher CRP (108.9 [96.5] mg/L vs. 70.6 [70.3] mg/L; p < 0.001). In the adjusted multivariate model, both were associated with poorer evolution: SA, OR 0.674 (95% CI, 0.551–0.826; p < 0.001); CRP, OR 1.002 (95% CI, 1.001–1.004; p = 0.003). The CRP/SA model had a similar predictive capacity (honest AUC, 0.8135 [0.7865–0.8405]), with a continuously increasing risk and cutoff value of 25 showing the highest predictive capacity (OR, 1.470; 95% CI, 1.188–1.819; p < 0.001). (4) Conclusions: SA and CRP are good independent predictors of patients hospitalized with COVID-19. For the CRP/SA ratio value, 25 is the cutoff for poor clinical course.

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Nutritional and Functional Impact of Acute SARS-CoV-2 Infection in Hospitalized Patients

Cited by 11 publications

References 32 publications

Determinants of Cause-Specific Mortality and Loss of Independence in Older Patients following Hospitalization for COVID-19: The GeroCovid Outcomes Study

Determinants of Cause-Specific Mortality and Loss of Independence in Older Patients following Hospitalization for COVID-19: The GeroCovid Outcomes Study

Effects of Rehabilitation on Long-COVID-19 Patient’s Autonomy, Symptoms and Nutritional Observance

C-Reactive Protein and Serum Albumin Ratio: A Feasible Prognostic Marker in Hospitalized Patients with COVID-19

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