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Background: Organism can lead to excessive nutrient consumption in the infected state and increase nutritional risk, which is detrimental to the control of the infection and can further aggravate the disease. Objectives: To investigate the impact of nutritional risk and the NRS2002 score on disease progression and prognosis in patients with COVID-19. Methods: This was a retrospective cohort study including 1,228 COVID-19 patients, who were divided into a with-nutritional risk group (patients with NRS2002 score ≥ 3) and a without-nutritional risk group (patients with NRS2002 score < 3) according to the NRS2002 score at admission. The differences in clinical and outcome data between the two groups were compared, and the relationship between the NRS2002 score and the disease progression and prognosis of COVID-19 patients was assessed. Results: Of 1,228 COVID-19 patients, including 44 critical illness patients and 1,184 non-critical illness patients, the rate of harboring nutritional risk was 7.90%. Compared with those in the without-nutritional risk group, patients in the with-nutritional risk group had a significantly longer coronavirus negative conversion time, significantly lower serum albumin (ALB), total serum protein (TP) and hemoglobin (HGB) at admission, discharge or 2 weeks, a significantly greater proportion with 3 or more comorbidities, and a significantly higher rate of critical illness and mortality (all p < 0.001). Multiple regression analysis showed that nutritional risk, NRS2002 score and ALB at admission were risk factors for disease severity. In addition, nutritional risk, NRS2002 score and TP at admission were risk factors for prognosis. The NRS2002 score showed the best utility for predicting critical illness and death in COVID-19 patients. Conclusion: Nutritional risk and a high NRS2002 score are closely related to disease progression and poor prognosis in COVID-19 patients. For patients with NRS2002 score > 0.5, early intervention of malnutrition is needed to reduce the occurrence of critical disease. Additionally, for patients with NRS2002 score > 5.5, continuous nutritional support therapy is needs to reduce mortality and improve prognosis.Clinical Trial registration: [https://www.chictr.org.cn/historyversionpub.aspx?regno=ChiCTR2000034563], identifier [Chinese Clinical Trial Register ChiCTR2000034563].
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BACKGROUND AND AIMS: The current Covid-19 outbreak becomes a tremendous public health concern worldwide. Since a little information is available on nutritional status and its devastating effects on covid-19 complications in Iran, in the present study, we aimed to evaluate nutritional status of covid-19 population and its related factors. METHODS: We performed this observational study by recruiting 400 hospitalized covid-19 subjects. Thereafter, the needed clinical and para clinical data were collected and their nutritional status was then assessed using NRS-2002. RESULTS: Approximately 36% of the total sample size and 100% of the ICU- admitted cases were at the severe risk of malnutrition. The patients with NRS≥ 5 were significantly older (p < 0.0001). Non-survivals obtained higher scores in terms of both severity of disease (86%) and impaired nutritional status (67%), and this relationship was found to be statistically significant (p < 0.0001). In regard to the obtained prognostic inflammatory scores, 86% of the non-survivals obtained significantly highest scores for GPS (P = 0.015). CONCLUSION: Nutritional status has a considerable effect on clinical outcomes of covid-19 patients, which should be evaluated. Thereafter, rapid subsequent nutritional interventions must be implemented in this regard. As well, special attention must be paid to both elderly population and individuals with underlying diseases.
Subject(s)
COVID-19 , Malnutrition , Aged , Humans , Intensive Care Units , Malnutrition/complications , Nutrition Assessment , Nutritional StatusABSTRACT
Amaç: Malnütrisyon, yoğun bakım ünitelerinde (YBÜ) %28-78 sıklıkla görülen, morbidite ve mortalite artışı ile karakterize bir durumdur. Yatan hastalarda nütrisyon risk değerlendirilmesinde Beslenme Risk Tarama-2002 (NRS) kullanılmaktadır. Çalışmamızda, koronavirüs hastalığı-19 (COVID-19) pandemisinde YBÜ’mizde takip edilen hastaların nütrisyonel riskleri, komorbiditeleri ve yatıştaki laboratuvar parametrelerinin mortaliteye etkisini araştırmayı amaçladık. Gereç ve Yöntem: Etik kurul onayı sonrası Mart 2020-Mart 2021 tarihleri arasında YBÜ’de takip edilen hasta dosyaları retrospektif olarak tarandı. COVID-19 (+) olan (grup 1) ve olmayan (grup 2) hastaların yaşı ve cinsiyeti, yatıştaki laboratuvar testleri (hemoglobin, nötrofil/lenfosit oranı, ortalama korpüsküler volümü, albumin, protein, üre, kreatinin, ferritin değerleri) ve NRS skorları (NRS ≥3: kötü, NRS <3: iyi) kaydedildi. Hastaların YBÜ’de beslenmeye başlama zamanı-şekli (enteral, parenteral), ek hastalıkları ve sayısı, YBÜ ve hastanedeki toplam yatış süreleri ile mortalite zamanları kaydedildi. Bu süreçte mortaliteye etki eden risk faktörleri değerlendirildi. p<0,05 anlamlı kabul edildi. Bulgular: Çalışmaya dahil edilen 268 hastanın yaş ortalaması 64,76±16 yıl idi. Hastaların gruplara göre demografik özellikleri, yatıştaki NRS puanları ve laboratuvar verileri, YBÜ’de beslenmeye başlama zamanı ve şekli, YBÜ ve hastanedeki toplam yatış süreleri ile mortalite zamanları ve mortalite durumları Tablo 1’de gösterildi. Hipertansiyon (n=125, %46,6) ve diabetes mellitus (DM) (n=95, %35,4) en sık görülen komorbiditelerdi. Yüz yetmiş sekiz hasta eksitus oldu (%66,4). Bir yıllık pandemi sürecinde YBÜ’mizde malnütrisyon sıklığı %73,1 iken COVID-19 (+) hastalarda bu oran %96,7 idi. Logistik regresyon analizine göre hasta ayrımı yapılmaksızın mortaliteye etki eden risk faktörleri Tablo 2’de sunulmuştur. Hastaların demografik özellikleri, yatıştaki NRS, laboratuvar değerlerinin,YBÜ’de beslenmeye başlama zamanı-şekli ile YBÜ ve hastanedeki toplam yatış süreleri ile mortalite zamanları karşılaştırılması Sonuç: Serum albumini beslenmenin önemli göstergelerinden biri olması yanında kronik sistemik bir hastalığın varlığında düzeyi azalan negatif akut faz göstergesidir. Albumin düzeyi düşük hastalarda mortalitenin yüksek bulunması beklenir ki çalışmamızda da regresyon analizinde bu gösterilmiştir. COVID-19 pandemisinde yoğun bakım hastalarında ileri yaş, NRS ≥3, DM, kronik böbrek yetmezliği, nöropsikiyatrik hastalık ve malignite varlığı ile yatıştaki yüksek üre, ferritin ve düşük albumin seviyelerinin mortaliteyi artırdığı saptanmıştır. Yatış esnasında bu faktörlerin irdelenmesi, riskli gruplarda farklı yaklaşımların geliştirilmesine katkıda bulunabilir. (Turkish) [ FROM AUTHOR] Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread throughout the world, which becomes a global public health emergency. Undernourishment prolongs its convalescence and has an adverse effect on its prognosis, especially in diabetic patients. The purpose of this study was to evaluate the prevalence and characteristics of undernourishment and to determine how it is related to the prognostic outcomes in the diabetic patients with coronavirus disease 2019 (COVID-19). A retrospective, multicenter study was conducted in 85 diabetic COVID-19 patients from three hospitals in Hubei Province. All patients were assessed using the European Nutritional Risk Screening 2002 (NRS-2002) and other nutritional assessments when admitted. Of them, 35 (41.18%) were at risk of malnutrition (NRS score ≥3). Severe COVID-19 patients had a significantly lower level of serum albumin and prealbumin and higher NRS score than non-severe patients. Multivariate logistic regression analysis showed that serum prealbumin and NRS score increased the likelihood of progression into severe status ( P<0.05). Meanwhile, single factor and multivariate analysis determined that grade of illness severity was an independent predictor for malnutrition. Furthermore, prealbumin and NRS score could well predict severe status for COVID-19 patients. The malnutrition group (NRS score ≥3) had more severe illness than the normal nutritional (NRS score <3) group ( P<0.001), and had a longer length of in-hospital stay and higher mortality. Malnutrition is highly prevalent among COVID-19 patients with diabetes. It is associated with severely ill status and poor prognosis. Evaluation of nutritional status should be strengthened, especially the indicators of NRS-2002 and the level of serum prealbumin.
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Nutrition is a basic need and is crucial for the persistence of good health. This awareness has increased since December 2019 during the pandemic that the world is still facing. The importance of nutrition in infectious diseases was emphasized but the relationship between the severity of symptoms and nutrition status of individuals was not examined. This study compared the nutrition status of patients with COVID-19 admitted to the emergency service and the clinical severity of the disease. Based on the nutrition status of the 337 patients included in the study, 87.2% (294) of the patients were in the low-risk group while 12.8% (43) were in the high-risk group in terms of malnutrition. In the analysis conducted to examine the effect of nutrition on the severity of disease, the relationship between NRS 2002 and dyspnea, cough, weakness, fever, and other symptoms was statistically significant. It was concluded that healthy nutrition is crucial during the pandemic, and it is necessary to consider nutrition improvement as a way to cope with emerging viral infections.
Subject(s)
COVID-19 , Malnutrition , Humans , Nutrition Assessment , Nutritional Status , Risk FactorsABSTRACT
OBJECTIVE: This retrospective observational study aims to evaluate the prognostic accuracy of Modified Nutrition Risk in Critically ill (mNUTRIC) compared to Nutrition Risk Score-2002 (NRS-2002) in patients hospitalized in the intensive care unit due to severe pneumonia during the pandemic period. METHODS: RT-PCR test and Chest CT was performed in all patients in the emergency department pandemic area. The CURB-65 at the time of admission to the emergency department and Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential organ failure assessment score (SOFA), NRS-2002 and mNUTRIC scores 24 h after hospitalization in the intensive care unit were calculated. The analysis of the data was made in IBM SPSS Statistics Base 22.0 package program. RESULTS: One hundred and twenty-five patients found to have severe pneumonia based on the chest CT taken in the emergency department pandemic area and hospitalized in the intensive care unit were included in the study. A real-time reverse transcription PCR (RT-PCR) test was positive in 30.4% (n: 38) of the patients. Additional nutrition treatment was initiated in 54.4% of the patients. In the analytical evaluation to predict nutritional treatment needs, mNUTRIC's AUC value (AUC: 0.681, 95% 0.582-0.780, p < 0.001) was higher than NRS-2002. While 64.8% (n: 81) of the patients were discharged, 35.2% (n: 44) died. In the analytical evaluation to predict mortality, the AUC value of mNUTRIC had the highest value (AUC: 0.875, 95% CI 0.814-0.935, p < 0.001). CONCLUSION: The mNUTRIC score can predict at an early period the nutritional needs and mortality of patients with severe pneumonia during the Covid-19 pandemic.
Subject(s)
COVID-19 , Pneumonia , Critical Illness , Humans , Pandemics , Pneumonia/diagnosis , SARS-CoV-2ABSTRACT
OBJECTIVE: This study was designed to explore the impact of different scoring settings of disease severity on the accuracy of screening by NRS2002. METHODS: Patients with severe COVID-19 who were admitted to our hospital from January 26, 2020, to March 16, 2020, were enrolled in this study. The basic data, the scores of the NRS2002 score sheet, and the serum prealbumin (PAB) level when these patients were admitted were collected, and the reflection of NRS2002 scores under different disease severity score settings to abnormal patients was analyzed. RESULTS: 1. When the severity of the disease was set to 0 points, four of the six hospitalized patients with PAB levels below the lower normal limit were not screened out; 2. When the severity was set to 1 point, two patients with COVID-19 who developed to a severe stage during the treatment process were screened out, but three of the six hospitalized patients with PAB levels below the lower normal limit at admission were not screened out; 3. When the severity of the disease of a patient with severe COVID-19 and fever scored 2 points, and that of a patient without fever scored 1 point, two patients with COVID-19 who developed to the severe stage during the treatment process were screened out, and six patients who were hospitalized with PAB levels below the lower normal limit at admission were also screened out. CONCLUSION: When the severe degree of patients with COVID-19 and fever is rated as 2 points, and that of the patients without fever is rated as 1 point, it can more accurately reflect the severity degree of patients with undernourishment.
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RATIONALE: The prevalence of malnutrition and the provided nutritional therapy were evaluated in all the patients with SARS-CoV-2 infection (COVID-19) hospitalized in a 3rd level hospital in Italy. METHODS: A one-day audit was carried out recording: age, measured or estimated body weight (BW) and height, body mass index (BMI, kg/m2), 30-day weight loss (WL), comorbidities, serum albumin and C-reactive protein (CRP: nv < 0.5 mg/dL), hospital diet (HD) intake, oral nutritional supplements (ONS), enteral (EN) and parenteral nutrition (PN). Modified NRS-2002 tool and GLIM criteria were used for nutritional risk screening and for the diagnosis of malnutrition, respectively. RESULTS: A total of 268 patients was evaluated; intermediate care units (IMCUs, 61%), sub-intensive care units (SICUs, 8%), intensive care units (ICUs, 17%) and rehabilitation units (RUs, 14%): BMI: <18.5, 9% (higher in RUs, p = 0.008) and ≥30, 13% (higher in ICUs, p = 0.012); WL ≥ 5%, 52% (higher in ICUs and RUs, p = 0.001); CRP >0.5: 78% (higher in ICUs and lower in RUs, p < 0.001); Nutritional risk and malnutrition were present in 77% (higher in ICUs and RUs, p < 0.001) and 50% (higher in ICUs, p = 0.0792) of the patients, respectively. HD intake ≤50%, 39% (higher in IMCUs and ICUs, p < 0.001); ONS, EN and PN were prescribed to 6%, 13% and 5%, respectively. Median energy and protein intake/kg BW were 25 kcal and 1.1 g (both lower in ICUs, p < 0.05) respectively. CONCLUSIONS: Most of the patients were at nutritional risk, and one-half of them was malnourished. The frequency of nutritional risk, malnutrition, disease/inflammation burden and decrease intake of HD differed among the intensity of care settings, where the patients were managed according to the severity of the disease. The patient energy and protein intake were at the lowest limit or below the recommended amounts, indicating the need for actions to improve the nutritional care practice.