Nutritional risk and lactate dehydrogenase: prognostic value for mortality and nosocomial infections in COVID-19 patients with respiratory distress syndrome.

Abstract

Background: In severe SARS-CoV-2 infection, lactate dehydrogenase (LDH) may be used to assess severity and mortality in patients with respiratory distress due to COVID-19. Thus a new nutritional screening index is proposed: the NUTRIC Score-LDH, which combines the prognostic value of the mNUTRIC Score and LDH to timely identify patients with a higher risk of malnutrition and contribute to the restoration of health through adequate nutrition support. Objective: The purpose of this study is to analyze the prognostic value of the combination of the mNUTRIC score with LDH to assess the risk of mortality and the development of infections in patients with COVID-19. Methodology: A prospective observational study was performed in patients infected with SARS-CoV-2 who presented respiratory distress syndrome. Chi-squared test (X2) was performed to identify the association among indicators of nutritional risk (mNUTRIC Score and the mNUTRIC Score-LDH), mortality and the presence of infections. Subsequently, prognostic values were determined and a Cox regression analysis was used to identify the risk of mortality adjusted for age, sex, body mass index, history of type II diabetes mellitus, arterial hypertension, and immunization for COVID-19. Results: A total of 257 patients participated, 63.8% were male. Mortality reached 38.1% (89). In terms of nutritional risk, 31.9% (82) had a high NUTRIC Score-LDH. The relative risk of a high mNUTRIC Score-LDH in terms of mortality was 4.578 p<0.0001 with a 95% confidence interval (3.226-6.496), while a high mNUTRIC Score had a risk of 3.86 p<0.0001 with a 95% confidence interval (2.92-5.03). mNUTRIC Score-LDH, has a sensibility of 0.80 and a specificity of 0.82 versus mNUTRIC Score with a sensibility of 0.56 and a specificity of 0.95. Conclusions: The NUTRIC Score-LDH is a valid indicator of the risk of mortality in patients with COVID-19 and respiratory distress syndrome who are at high risk of malnutrition.