Systematic Review and Meta-Analysis: Malnutrition and In-Hospital Death in Adults Hospitalized with COVID-19

Abstract

Background: Malnutrition and increased malnutrition risk are frequently identified in hospitalized adults. The increase in hospitalization rates during the COVID-19 pandemic was accompanied by the documentation of adverse hospitalization outcomes in the presence of certain co-morbidities, including obesity and type 2 diabetes. It was not clear whether the presence of malnutrition increased in-hospital death in patients hospitalized with COVID-19. Objectives: To estimate the effect of malnutrition on in-hospital mortality in adults hospitalized with COVID-19; and secondarily, to estimate the prevalence of malnutrition in adults hospitalized with malnutrition during the COVID-19 pandemic. Methods: EMBASE, MEDLINE, PubMed, Google Scholar, and Cochrane Collaboration databases were queried using the search terms malnutrition and COVID-19 and hospitalized adults and mortality. Studies were reviewed using the 14-question Quality Assessment Tool for Studies with Diverse Designs (QATSDD) (questions appropriate for quantitative studies). Author names; date of publication; country; sample size; malnutrition prevalence; malnutrition screening/diagnostic method; number of deaths in malnourished patients; and number of deaths in adequately nourished patients were extracted. Data were analyzed using MedCalc software v20.210 (Ostend, Belgium). The Q and I2 tests were calculated; a forest plot was generated, and the pooled odds ratio (OR) with 95% confidence intervals (95%CI) were calculated using the random effects model. Results: Of the 90 studies identified, 12 were finally included in the meta-analysis. In the random effects model, malnutrition or increased malnutrition risk increased odds of in-hospital death by more than three-fold: OR 3.43 (95% CI 2.549–4.60), p < 0.001. The pooled prevalence estimate for malnutrition or increased malnutrition risk was 52.61% (95% CI 29.50–75.14%). Discussion and Conclusions: It is clear that malnutrition is an ominous prognostic sign in patients hospitalized with COVID. This meta-analysis, which included studies from nine countries on four continents with data from 354,332 patients, is generalizable.

Malnutrition and the Post-Acute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Multi-Institutional Population-Based Propensity Score-Matched Analysis

“…Consistent with previous studies, malnutrition amplifies the severity of infectious diseases, including COVID-19 [3,12,[40][41][42][43][44]. A meta-analysis of 12 studies demonstrated a similar trend, showing that malnourished patients had significantly higher odds of inhospital mortality (odds ratio = 3.43, 95% CI: 2.55-4.60) during a 90-day follow-up [45].…”

“…Consistent with previous studies, malnutrition amplifies the severity of infectious diseases, including COVID-19 [ 3 , 12 , 40 , 41 , 42 , 43 , 44 ]. A meta-analysis of 12 studies demonstrated a similar trend, showing that malnourished patients had significantly higher odds of in-hospital mortality (odds ratio = 3.43, 95% CI: 2.55–4.60) during a 90-day follow-up [ 45 ]. Our study builds on these findings by including non-hospitalized patients and extending the follow-up duration, thus providing a more comprehensive view of the impact of malnutrition on COVID-19 outcomes in various settings.…”

The relationship between comprehensive geriatric assessment on the pneumonia prognosis of older adults: a cross-sectional study

“…Many studies suggest also that frailty is related to the hospitalization rate, severity, mortality rate, and LOS [ 5 , 21 – 23 ]. The higher incidence of malnutrition in hospitalized patients is an ominous sign of poor prognosis [ 24 – 27 ]. In addition, the invasion of the SARS-CoV-2 into peripheral nerves can lead to loss of smell, impaired sensory function of the oropharynx, swallowing disorders, and an increased risk of death [ 28 ].…”

Factores de riesgo de la desnutrición hospitalaria y mortalidad en pacientes hospitalizados: Una revisión sistemática, periodo 2018-2023

“…Estudios han encontrado que la edad del paciente es un factor que puede influenciar en el grado de desnutrición una vez que estos han sido hospitalizados (Behiry & Salem, 2019;González-Franco et al, 2020;Lovera Montilla & Cáceres Villota, 2023). Mientras más edad presente el paciente, el riesgo de desnutrición aumenta y por tanto también aumenta el riesgo de fallecer (Bhirommuang et al, 2019;Boaz & Kaufman-Shriqui, 2023;Koroušić Seljak et al, 2020;Pereira et al, 2021;Ting et al, 2019) sobre todo con afectaciones como el COVID 19 (Velázquez Alva et al, 2021) y enfermedades renales (Sánchez-Tocino et al, 2022). En el caso de los pacientes oncológicos hospitalizados, no hubo diferencias respecto a las edades, sin embargo presentan las tasas más elevadas de desnutrición hospitalaria (Chimera-Khombe et al, 2022).…”