Outcomes of nutritionally at-risk Coronavirus Disease 2019 (COVID 19) patients admitted in a tertiary government hospital: A follow-up study of the MalnutriCoV study

Abstract

Background and aims: The prevalence of malnutrition among adult Filipino patients with COVID 19 is 71.83%. Malnutrition has long been associated with poor outcomes among patients with pneumonia. This may be due to the increased risk of malnourished patients to develop impaired muscle and respiratory function. We aimed to determine the outcomes of adult COVID 19 patients admitted in a tertiary government hospital accordingly to nutrition status and risk. Methods: Retrospective study on the adult COVID 19 patients admitted from July 15 to September 15, 2020 who were screened using the Philippine Society for Parenteral and Enteral Nutrition modified Subjective Global Assessment Grade tool. Chi-square or Fisher exact test, as well as ManneWhitney U test or KruskaleWallis with post-hoc Dunn test, as appropriate were done. Survival analysis for mortality was done with right-censored data length of initial admission in days. Cox proportional hazard regression was done to determine the association of the main variables of interest with mortality with a 95% confidence interval. Results: Malnourished patients were 30% less likely to be discharged [HR 0.70 95% CI (0.50, 0.97)]; malnutrition was also associated with length of hospital stay as those who were malnourished had longer lengths of hospital stay of about 4 days on the average [HR 3.55 95% CI (0.83, 6.27)]. High nutrition risk was significantly associated with length of hospital stay [HR 4.36 95% CI (0.89, 7.83)]. Conclusion:The only risk factor for mortality shown in this study is ICU transfer. Malnutrition, moderate nutrition risk, and high nutrition risk were risk factors of having longer lengths of hospital stays. While only malnutrition was the risk factor for being less likely to be discharged. We reiterate that nutrition assessment and support are important in mitigating the effects of COVID 19.

Impact of COVID-19 Infection and Persistent Lingering Symptoms on Patient Reported Indicators of Nutritional Risk and Malnutrition

“…This is concerning for both acute and more long-term COVID-19 outcomes. Recent research has shown that malnutrition prolongs hospitalization in COVID-19 patients by almost 12 days [ 24 , 25 ]. In addition, nutritional risk is associated with higher risk of developing severe COVID-19 infection [ 26 ].…”

Nutritional status associated with clinical outcomes among patients hospitalized with COVID‐19: A multicenter prospective study in Egypt

“…This study found that poor nutritional status was significantly associated with poor prognosis and high mortality. Similarly, previous studies showed that poor nutritional status is associated with a longer hospital stay, a higher rate of intensive care unit admission, and an increased mortality rate (Larrazabal et al, 2021;Nicolau et al, 2021). A retrospective study of 63 patients with COVID-19 hospitalized in China found that patients with higher NRS scores had higher white blood cell counts, lower lymphocyte counts, higher C-reactive protein and serum procalcitonin levels, severer COVID-19, and higher mortality rates (Y.…”

“…Recent studies have shown that malnutrition is more prevalent in patients with COVID‐19, especially those in a critical state (Bedock et al, 2020; Wierdsma et al, 2021). Moreover, poor nutritional status is associated with a longer hospital stay, a higher rate of intensive care unit admission and an increased mortality rate (Larrazabal et al, 2021; Nicolau et al, 2021).…”

“…To date, only a few studies have examined the relationship between nutritional status and unfavorable clinical outcomes (i.e. transfer to ICU or death) among patients hospitalized with COVID‐19, in France, the Philippines, and Spain (Bedock et al, 2020;Larrazabal et al, 2021; Nicolau et al, 2021). The methods of these studies vary from cross‐sectional data collection in a single center with a relatively small sample, to data collection via phone interviews, and the self‐reporting of body height and weight by patients (Nicolau et al, 2021); as well as retrospective data collection from a single center (Larrazabal et al, 2021) using the Subjective Global Assessment tool (Larrazabal et al, 2021; Nicolau et al, 2021).…”

COVID-19: Lessons on malnutrition, nutritional care and public health from the ESPEN-WHO Europe call for papers

“…Several studies published in the ESPEN-WHO Europe call have further confirmed and dissected this association. In non-ICU patients with COVID-19, poor nutritional state was associated with higher mortality in a systematic review [31] and with higher risk of transfer to ICU from hospital wards [30] as well as longer length of hospital stay [30,33], active complications at discharge [34], and ultimately negative outcomes and mortality in several studies and databases [29,30,34,35]. Specifically in geriatric settings, malnutrition risk at admission predicted hospital length of stay [27] while MNA-assessed malnutrition also predicted in-hospital mortality in a large population cohort [36].…”