High risk of malnutrition among hospitalised coronavirus disease 2019 (COVID-19) patients is associated with mortality and other clinical outcomes
Sandra Dögg Guðnadóttir, Ingibjörg Gunnarsdóttir, Ubaldo Benitez Hernandez, Áróra Rós Ingadóttir
Clinical Nutrition ESPEN, doi:10.1016/j.clnesp.2024.02.023
Introduction: Increasing evidence indicates an association between nutritional status and Coronavirus disease 2019 (COVID-19) disease severity. The aim of the study was to describe the risk of malnutrition, body mass index (BMI) and vitamin D status of hospitalised COVID-19 patients and assess whether they are associated with duration of hospital stay, intensive care unit (ICU) admission, mechanical ventilation, and mortality. Methods: The study is a descriptive retrospective study of 273 patients with COVID-19 admitted to Hospital from February 2020 to March 2021. Patients were screened for risk of malnutrition using a validated screening tool. BMI was calculated from height and weight. Insufficient Vitamin D status was defined as 25(OH)vitD <50 nmol/L. Logistic regression analysis was used to assess the association between indicators of nutritional status of patients with COVID-19, and outcomes such as duration of stay >7 days, ICU admission, mechanical ventilation, and mortality. Interaction between risk of malnutrition and BMI of 30 kg/m 2 was assessed using the likelihood ratio test with hospital stay, ICU admission, mechanical ventilation, and mortality as outcomes. Results: Screening for risk of malnutrition identified 201 (74%) patients at a medium to high risk of malnutrition. Patients defined as being at a medium or high risk of malnutrition were more likely to be hospitalised for >7 days compared to those defined as low risk (OR: 10.72; 95% CI: 3.9e29.46; p < 0.001 and OR: 61.57; 95% CI: 19.48e194.62; p < 0.001, respectively). All patients who were admitted to ICU (n ¼ 41) and required mechanical ventilation (n ¼ 27) were defined as having medium or high risk of malnutrition. High risk of malnutrition was also associated with increased odds of mortality (OR: 8.87; 955 CI 1.08e72,96; p ¼ 0.042). BMI of 30 kg/m 2 (43%) and 25(OH)vitD <50 nmol/L (20%) were not associated with duration of stay >7 days or mortality, although BMI 30 kg/m 2 was associated with increased risk of ICU admission (OR: 7.12; 95% CI: 1.59e31.94; p ¼ 0.010) and mechanical ventilation (OR: 8.86; 95% CI: 1.12e69.87; p ¼ 0.038). Interactions between risk of malnutrition and BMI 30 kg/m 2 were not significant to explain the outcomes of hospital stay >7 days, ICU admission, mechanical ventilation, or mortality. Conclusion: High risk of malnutrition among hospitalised COVID-19 patients was associated with longer duration of hospital stay, ICU admission, mechanical ventilation and mortality, and BMI 30 kg/m 2 was associated with ICU admission and mechanical ventilation. Insufficient Vitamin D status was not associated with duration of hospital stay, ICU admission, mechanical ventilation, or mortality.
Author contribution Sandra D€ ogg Guðnad ottir: Formal analysis, Investigation, Writing-Original Draft, Visualization, Funding acquisition. Ar ora R os Ingad ottir: Conceptualization, Methodology, Writing e Review and Editing, Visualization, Supervision, Funding acquisition. Ingibj€ org Gunnarsd ottir: Writing e Review and Editing, Visualization, Supervision, Funding acquisition. Ubaldo Benitez Hernandez: Statistical consulting.
Declaration of competing interest The authors have no conflict of interest to declare.
Appendix A. Supplementary data Supplementary data to this article can be found online at https://doi.org/10.1016/j.clnesp.2024.02.023.
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