Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr 6;17(7):1278.
doi: 10.3390/nu17071278.

Nutritional Risk Score (NRS-2002) as a Predictor of In-Hospital Mortality in COVID-19 Patients: A Retrospective Single-Center Cohort Study

Jan Ilkowski  1 , Przemysław Guzik  2   3 , Aleksandra Kaluźniak-Szymanowska  4 , Piotr Rzymski  5 , Jerzy Chudek  6 , Katarzyna Wieczorowska-Tobis  4   7
Affiliations

Nutritional Risk Score (NRS-2002) as a Predictor of In-Hospital Mortality in COVID-19 Patients: A Retrospective Single-Center Cohort Study

Jan Ilkowski et al. Nutrients. .

Abstract

Background: Malnutrition is an often-overlooked yet potentially crucial factor influencing COVID-19 outcomes. Poor nutritional status weakens immune function, increases infection susceptibility, and worsens prognoses in hospitalized patients. However, its specific role in COVID-19 mortality remains insufficiently characterized. The aim of the study was to assess the impact of malnutrition, as determined by the Nutritional Risk Score (NRS-2002), on in-hospital mortality. Methods: This retrospective, single-center study analyzed 222 patients hospitalized with COVID-19 during the Delta variant predominance. Thirty-one patients died during hospitalization. Malnutrition (NRS ≥ 3) emerged as a strong predictor of in-hospital mortality in univariate Cox proportional hazard models, both before and after adjustment for potential confounders. Adjusted analyses used 10 different sets of three out of five mortality-related variables. Results: Hazard ratios for malnutrition ranged from 3.19 to 5.88 (p < 0.01 for all models), highlighting its substantial impact on mortality risk. The high Nagelkerke's R2 values (0.66-0.77) indicate that the models explained a significant proportion of mortality variance. Nutritional status plays a critical role in COVID-19 survival among hospitalized patients. Conclusions: Given its simplicity and effectiveness, integrating the NRS-2002 into routine clinical assessments may help identify high-risk patients early. Future research should explore whether early nutritional interventions can mitigate the mortality risks associated with malnutrition in severe COVID-19 cases or patients with other infectious diseases or acute inflammation.

Keywords: COVID-19; Nutritional Risk Score (NRS-2002); in-hospital mortality; malnutrition; risk assessment.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curves presenting the in-hospital mortality rate in COVID-19 patients with increased risk of malnutrition at admission and those with normal nutrition status.
See this image and copyright information in PMC

References

    1. Flisiak R., Rzymski P., Zarębska-Michaluk D., Ciechanowski P., Dobrowolska K., Rogalska M., Jaroszewicz J., Szymanek-Pasternak A., Rorat M., Kozielewicz D., et al. Variability in the Clinical Course of COVID-19 in a Retrospective Analysis of a Large Real-World Database. Viruses. 2023;15:149. doi: 10.3390/v15010149. - DOI - PMC - PubMed
    1. O’Driscoll M., Ribeiro Dos Santos G., Wang L., Cummings D.A.T., Azman A.S., Paireau J., Fontanet A., Cauchemez S., Salje H. Age-Specific Mortality and Immunity Patterns of SARS-CoV-2. Nature. 2021;590:140–145. doi: 10.1038/s41586-020-2918-0. - DOI - PubMed
    1. Zhang J.-J., Dong X., Liu G.-H., Gao Y.-D. Risk and Protective Factors for COVID-19 Morbidity, Severity, and Mortality. Clin. Rev. Allergy Immunol. 2023;64:90–107. doi: 10.1007/s12016-022-08921-5. - DOI - PMC - PubMed
    1. Bauer J.M., Morley J.E. Editorial: COVID-19 in Older Persons: The Role of Nutrition. Curr. Opin. Clin. Nutr. Metab. Care. 2021;24:1–3. doi: 10.1097/MCO.0000000000000717. - DOI - PMC - PubMed
    1. Larrazabal R.B., Chiu H.H.C., Palileo-Villanueva L.A.M. 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. Clin. Nutr. ESPEN. 2021;43:239–244. doi: 10.1016/j.clnesp.2021.04.008. - DOI - PMC - PubMed

LinkOut - more resources