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Observational Study
. 2021 Apr;40(4):2154-2161.
doi: 10.1016/j.clnu.2020.09.040. Epub 2020 Oct 1.

Nutritional risk and therapy for severe and critical COVID-19 patients: A multicenter retrospective observational study

Gang Li  1 , Chen-Liang Zhou  2 , Yuan-Ming Ba  3 , Ye-Ming Wang  4 , Bin Song  5 , Xiao-Bin Cheng  6 , Qiu-Fen Dong  7 , Liu-Lin Wang  8 , Sha-Sha You  9
Affiliations
Observational Study

Nutritional risk and therapy for severe and critical COVID-19 patients: A multicenter retrospective observational study

Gang Li et al. Clin Nutr. 2021 Apr.

Abstract

Objective: To evaluate the nutritional risk and therapy in severe and critical patients with COVID-19.

Methods: A total of 523 patients enrolled from four hospitals in Wuhan, China. The inclusion time was from January 2, 2020 to February 15. Clinical characteristics and laboratory values were obtained from electronic medical records, nursing records, and related examinations.

Results: Of these patients, 211 (40.3%) were admitted to the ICU and 115 deaths (22.0%). Patients admitted to the ICU had lower BMI and plasma protein levels. The median Nutrition risk in critically ill (NUTRIC) score of 211 patients in the ICU was 5 (4, 6) and Nutritional Risk Screening (NRS) score was 5 (3, 6). The ratio of parenteral nutrition (PN) therapy in non-survivors was greater than that in survivors, and the time to start nutrition therapy was later than that in survivors. The NUTRIC score can independently predict the risk of death in the hospital (OR = 1.197, 95%CI: 1.091-1.445, p = 0.006) and high NRS score patients have a higher risk of poor outcome in the ICU (OR = 1.880, 95%CI: 1.151-3.070, p = 0.012). After adjusted age and sex, for each standard deviation increase in BMI, the risk of in-hospital death was reduced by 13% (HR = 0.871, 95%CI: 0.795-0.955, p = 0.003), and the risk of ICU transfer was reduced by 7% (HR = 0.932, 95%CI:0.885-0.981, p = 0.007). The in-hospital survival time of patients with albumin level ≤35 g/L was significantly decreased (15.9 d, 95% CI: 13.7-16.3, vs 24.2 d, 95% CI: 22.3-29.7, p < 0.001).

Conclusion: Severe and critical patients with COVID-19 have a high risk of malnutrition. Low BMI and protein levels were significantly associated with adverse events. Early nutritional risk screening and therapy for patients with COVID-19 are necessary.

Keywords: COVID-19; NRS score; NUTRIC score; Nutritional risk.

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Figures

Fig. 1
Fig. 1
Cumulative hospitalization mortality between the different groups of NUTRIC score and nutrition therapy timing.
Fig. 2
Fig. 2
Kaplan–Meier curves stratified according to BMI and albumin.
Fig. 3
Fig. 3
Kaplan–Meier analysis and Cox proportional risk model comparing elevated and low NRS scores.
See this image and copyright information in PMC

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