Nutritional Risk Assessment Scores Effectively Predict Mortality in Critically Ill Patients with Severe COVID-19

Abstract

Background: Malnutrition predicts a worse outcome for critically ill patients. However, quick, easy-to-use nutritional risk assessment tools have not been adequately validated. Aims and Methods: The study aimed to evaluate the role of four biological nutritional risk assessment instruments (the Prognostic Nutritional Index—PNI, the Controlling Nutritional Status Score—CONUT, the Nutrition Risk in Critically Ill—NUTRIC, and the modified NUTRIC—mNUTRIC), along with CT-derived fat tissue and muscle mass measurements in predicting in-hospital mortality in a consecutive series of 90 patients hospitalized in the intensive care unit for COVID-19-associated ARDS. Results: In-hospital mortality was 46.7% (n = 42/90). Non-survivors had a significantly higher nutritional risk, as expressed by all four scores. All scores were independent predictors of mortality on the multivariate regression models. PNI had the best discriminative capabilities for mortality, with an area under the curve (AUC) of 0.77 for a cut-off value of 28.05. All scores had an AUC above 0.72. The volume of fat tissue and muscle mass were not associated with increased mortality risk. Conclusions: PNI, CONUT, NUTRIC, and mNUTRIC are valuable nutritional risk assessment tools that can accurately predict mortality in critically ill patients with COVID-19-associated ARDS.

Prognostic Nutritional Index, Controlling Nutritional Status (CONUT) Score, and Inflammatory Biomarkers as Predictors of Deep Vein Thrombosis, Acute Pulmonary Embolism, and Mortality in COVID-19 Patients

“…In regard to the predictive role of nutritional markers, in the meta-analysis published by Hung et al [ 52 ], in which 13 studies were included, and a total number of 4204 COVID-19 patients, it was demonstrated that PNI is a predictor of mortality. Moreover, research by Bodolea et al [ 53 ] resulted in PNI > 28.05 (HR:0.91; p = 0.01), and a CONUT Score > 7.5 (HR:1.15; p = 0.01) becoming associated with mortality, in the case of 90 COVID-19 patients with the severe form.…”

“…In terms of nutritional status, the prognostic nutritional index (PNI) and controlling nutritional status (CONUT) scores are associated with disease severity and have a predictive role in COVID-19 patient mortality [ 52 , 53 , 54 , 55 , 56 , 57 ]…”

Moderate-to-Severe Malnutrition Identified by the Controlling Nutritional Status (CONUT) Score Is Significantly Associated with Treatment Failure of Periprosthetic Joint Infection

“…Our study preliminarily illustrated the clinical guidance of the CONUT score as a reliable nutritional screening tool. Similarly, CONUT has been demonstrated to have good prognostic value in cancers and other infections [ 35 , 55 , 56 ]. Although the exact mechanism is uncertain, this association may be explained by the nutritional and immune-related parameters in CONUT [ 57 ].…”

“…As of today, nutritional assessment can be achieved effectively with different measurable immunonutritional screening tools (INST), such as Controlling Nutritional Status (CONUT) [ 32 ], Nutritional Risk Index (NRI) [ 33 ], and Naples Prognostic Score (NPS) [ 34 ]. These tools have demonstrated promising potential in the nutritional and prognostic assessment of various diseases [ 35 , 36 , 37 ]. Another major advantage of them is the availability and feasibility of the included parameters in many hospitals.…”

Evaluation of the effectiveness of the modified nutrition risk in the critically ill (mNUTRIC) score in critically ill patients affected by COVID-19 admitted to the intensive care unit (ICU)

“…Survived patients had a lower score than deceased individuals. Previous studies have demonstrated that NUTRIC can be used as a predictor of malnutrition risk and mortality in critically ill COVID-19 patients and a higher NUTRIC score was associated with a higher mortality rate [ 52 – 55 ].…”