Prognostic Nutritional Index and Oxygen Therapy Requirement Associated With Longer Hospital Length of Stay in Patients With Moderate to Severe COVID-19: Multicenter Prospective Cohort Analyses

Abstract

PurposeTo evaluate whether the prognostic nutritional index (PNI) is related to the oxygen therapy requirement at hospital admission and to ascertain the prognostic effect of the PNI and the oxygen therapy requirement as predictors of hospital length of stay in patients with moderate to severe coronavirus disease 2019 (COVID-19).MethodsThis is a post-hoc analysis in hospitalized patients with moderate to severe COVID-19. The participants were categorized: (1) non-oxygen therapy (moderate COVID-19 not requiring oxygen therapy); (2) nasal cannula therapy (severe COVID-19 requiring nasal cannula oxygen therapy); and (3) high-flow therapy (severe COVID-19 requiring high-flow oxygen therapy). PNI was calculated for each patient according to the following equation: serum albumin [g/dL] × 10 + total lymphocyte count [per mm3] × 0.005. The participants were categorized into malnutrition (PNI <40), mild malnutrition (PNI 40–45), and non-malnutrition (PNI > 45).ResultsAccording to PNI, malnutrition was more prevalent in the high-flow therapy group (94.9%; P < 0.001) with significantly lower PNI compared to both groups even after adjusting for the center and C-reactive protein. Patients in the high-flow therapy group [9 days (95% CI 7.2, 10.7), P < 0.001] and malnutrition status [7 days (95% CI 6.6, 7.4), P = 0.016] showed a significant longer hospital length of stay compared to their counterparts. The multivariable Cox proportional hazard models showed significant associations between both oxygen therapy requirement and PNI categories and hospital discharge.ConclusionIn addition to oxygen therapy requirement, low PNI was associated with longer hospital length of stay. Our findings suggest that PNI could be useful in the assessment of nutritional status related to the prognosis of patients with moderate to severe COVID-19.

Nutrition practices in hospitalized adults receiving noninvasive forms of respiratory support: A scoping review

“…Of note is the inconsistency in nutrition assessment methods reported ( n = 5), reflecting current guidelines, which do not specifically recommend just one method to quantify malnutrition 11,40 . Rates of malnutrition in this review varied from 31% in patients with COPD 24 to 100% in a population with COVID‐19 20 . Whereas similar rates of malnutrition have been reported in studies recruiting patients with COPD (30% malnourished), 41 other studies have reported much lower rates of malnutrition in those with COVID‐19 (45% malnourished) 42 .…”

“…Studies were categorized into the nutrition parameters they reported on (Table 4), with some studies addressing multiple parameters. Five studies reported results related to route of nutrition, 14,17,21,23,24 five on nutrition assessment, 16,18–20,24 two on anthropometry, 18,22 one on quantifying nutrition intake, 24 and one on nutrition screening 15 …”

“…Five studies included a nutrition assessment, four in patients receiving NIV 16,18,19,24 and one in patients receiving HFNC 20 . The reported nutrition assessment tools varied, including Global Leadership Initiative on Malnutrition (GLIM), 19 Prognostic Nutritional Index (PNI), 20 and Subjective Global Assessment (SGA) 24 .…”

“…One study reported body mass index (BMI; calculated as weight [kg] divided by height squared [m 2 ]) and serum albumin level as an assessment of nutrition status, 16 and one reported rates of “undernutrition” but not the assessment method used 18 . Rates of malnutrition in studies using a validated assessment tool were (1) GLIM, 45% malnourished ( n = 9/20) 19 ; (2) PNI, 100% malnourished ( n = 39/39) 20 ; and (3) SGA, 31% malnourished ( n = 11/36) 24 …”

“…Overall, all were full-text articles published between 2009 and 2022, with over 70% of studies (n = 8) published in the last 5 years. 14,[16][17][18][19][20][21][22] Most studies were observational (n = 9) [14][15][16][17][18][19]21,23,24 and single center, 14,15,[17][18][19][21][22][23][24] and eight included <100 participants (Table 3).…”