A modified nutrition risk screening 2002 predicts the risk of death among hospitalized patients with COVID-19.

OBJECTIVES: The aim of this study was to evaluate the ability of a modified Nutrition Risk Screening 2002 (modified NRS) compared with other nutrition screening tools such as NRS 2002, Mini Nutrition Assessment Short Form (MNA-SF), and Malnutrition Universal Screening Tool (MUST) on predicting the risk of death in patients with coronavirus disease 2019 (COVID-19). METHODS: We retrospectively collected data of patients who were admitted to the West campus of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 25th, 2020 to April 24th, 2020. The nutritional status of the patients was assessed by modified NRS, NRS 2002, MNA-SF, and MUST. According to the score of modified NRS, patients were divided into malnutrition risk group (score ≥3) and normal nutrition group (score <3). Clinical characteristics were compared between the two groups. Kaplan meier survival curve was used to analyze the difference of compositing survival rate between the two groups. The predictive efficacy of different nutritional scales on the outcome of death was detected by Receiver operating characteristic (ROC) analysis. RESULTS: The modified NRS, NRS 2002, MNA-SF, and MUST identified malnutrition risk in 71.4%, 57.9%, 73.9%, and 43.4% of the patients, respectively. The patients were divided into malnutrition risk group and normal nutrition group by modified NRS score. Patients in the malnutrition risk group were older (65 y vs. 56 y) and with more severe and critical cases (42.30% vs. 5.20%) and diabetes cases (21.50% vs. 9.80%), worse prognosis (death of 13.80% vs. 0.50%), longer hospital stay (29 days vs. 23 days), lower albumin (31.85 g/L vs. 38.55 g/L) and prealbumin (201.95 mg/L vs. 280.25 mg/L) compared with the normal nutrition group (P were <0.001, respectively). There were more patients with chronic respiratory disease in malnutrition risk group (9.70 vs. 2.10%, P = 0.001). BMI was lower in malnutrition risk group (23.45 kg/m2vs. 24.15 kg/m2, P = 0.017). Kaplan meier survival curve demonstrated that the survival of malnutrition risk group was significantly lower than normal nutrition group (P < 0.001). The area under the ROC curve (AUC) of the modified NRS scale (0.895) outperformed NRS 2002 (0.758), MNA-SF (0.688), and MUST (0.485). The former three scales could predict the risk of death (P were < 0.001), while MUST could not (P = 0.690). CONCLUSIONS: Patients with COVID-19 at risk of malnutrition have a worse prognosis than those with normal nutrition. The modified NRS scale could effectively predict the risk of death among patients with COVID-19.

Risk of Malnutrition Is Common in Patients with Coronavirus Disease 2019 (COVID-19) in Wuhan, China: A Cross-sectional Study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) has quickly spread across the world. However, the nutritional status of COVID-19 patients has not yet been extensively examined. OBJECTIVES: The aim of this study was to evaluate the nutritional status of COVID-19 patients and to identify factors independently associated with malnutrition risk. METHODS: In this single-center, cross-sectional study, we analyzed data from 760 hospitalized COVID-19 patients between 29 January 2020 and 15 March 2020. Based on the Nutrition Risk Screening (NRS) 2002 score, we divided patients into the normal nutrition group (NRS score <3) and the malnutrition risk group (NRS score ≥3). The associations of age, gender, symptoms, comorbidities, BMI, serum albumin and prealbumin concentrations, disease severity, activities of daily living (ADL) score, and clinical outcomes with malnutrition risk were analyzed. Multivariable logistic regression analysis was used to identify independent factors associated with malnutrition risk. RESULTS: Of patients with COVID-19, 82.6% were at risk of malnutrition. There were statistical differences in the age, incidence of fever, BMI, serum albumin and prealbumin concentrations, ADL score, and disease severity between the 2 groups. Multivariable logistic regression analysis revealed that age ≥65 y (vs. <65 y; OR: 5.40; P < 0.001), serum albumin <35 g/L (vs. ≥35 g/L; OR: 3.61; P < 0.001), serum prealbumin <150 mg/L (vs. ≥150 mg/L; OR: 2.88; P = 0.042), critical cases (vs. moderate cases; OR: 4.46; P < 0.001), ADL score 41-60 (vs. ADL score 100; OR: 4.50; P = 0.012), and ADL score ≤40 (vs. ADL score 100; OR: 9.49; P < 0.001) were significantly associated with the risk of malnutrition in COVID-19 patients. CONCLUSIONS: This study showed that prevalence of malnutrition risk was high in COVID-19 patients. Older age, low serum albumin and prealbumin concentrations, ADL score <60, and disease severity were independent factors associated with malnutrition risk.