Association of Different Malnutrition Parameters and Clinical Outcomes among COVID-19 Patients: An Observational Study

Abstract

Background: Malnutrition is highly prevalent in medical inpatients and may also negatively influence clinical outcomes of patients hospitalized with COVID-19. We analyzed the prognostic implication of different malnutrition parameters with respect to adverse clinical outcomes in patients hospitalized with COVID-19. Methods: In this observational study, consecutively hospitalized adult patients with confirmed COVID-19 at the Cantonal Hospital Aarau (Switzerland) were included between February and December 2020. The association between Nutritional Risk Screening 2002 (NRS 2002) on admission, body mass index, and admission albumin levels with in-hospital mortality and secondary endpoints was studied by using multivariable regression analyses. Results: Our analysis included 305 patients (median age of 66 years, 66.6% male) with a median NRS 2002-score of 2.0 (IQR 1.0, 3.0) points. Overall, 44 patients (14.4%) died during hospitalization. A step-wise increase in mortality risk with a higher nutritional risk was observed. When compared to patients with no risk for malnutrition (NRS 2002 < 3 points), patients with a moderate (NRS 2002 3−4 points) or high risk for malnutrition (NRS 2002 ≥ 5 points) had a two-fold and five-fold increase in risk, respectively (10.5% vs. 22.7% vs. 50.0%, p < 0.001). The increased risk for mortality was also confirmed in a regression analysis adjusted for gender, age, and comorbidities (odds ratio for high risk for malnutrition 4.68, 95% CI 1.18 to 18.64, p = 0.029 compared to patients with no risk for malnutrition). Conclusions: In patients with COVID-19, the risk for malnutrition was a risk factor for in-hospital mortality. Future studies should investigate the role of nutritional treatment in this patient population.

Keywords: COVID-19; albumin; body mass index; in-hospital outcomes; nutritional risk screening 2002.

Figure 1

Study flowchart. A total of 305 patients were included in the final analysis. NRS 2002, nutritional risk screening 2002.

Figure 2

Adjusted odds ratios in-hospital mortality stratified by (a) NRS 2002 < 3 vs. NRS 2002 ≥ 3; (b) BMI < 20 if age < 70, BMI < 22 if age ≥ 70 vs. BMI ≥ 20 if age < 70, BMI ≥ 22 if age ≥ 70; (c) albumin levels < 34.0 g/L vs. ≥34.0 g/L in pre-specified subgroups. BMI, body mass index; NRS 2002, nutritional risk screening 2002; OR, odds ratio; CI, confidence interval, NA, not applicable. * adjusted for gender and age-adjusted Charlson comorbidity index (ACCI).