Exploring outcomes in hospitalized patients with COVID-19 based on nutritional status: Comparing those with and without a cancer diagnosis.

Abstract

e23068 Background: This study explores how nutritional status impacts COVID-19 outcomes, particularly in patients with cancer. Obesity is known to heighten risk of adult respiratory distress syndrome in COVID-19, malnutrition and its associated effects related to the immune response, respiratory compromise, debility, and other adverse outcomes has not been well defined in this patient population. Methods: In this retrospective cohort study, we examined data from the Charleston Area Medical Center’s (CAMC) COVID-19 Registry, involving 5,479 adult, symptomatic, PCR-positive COVID-19 hospitalized patients (3/1/20 to 1/20/24). Low nutritional status (LNS) was defined as Body Mass Index (BMI) < 18.5 kg/m² or serum albumin < 3.5g/dL). Demographics, comorbidities, lab values, treatments, and outcomes were assessed. Propensity score matching (3:1) non-cancer patients vs those with an active cancer diagnosis was undertaken using sex, age, and BMI. SAS 9.4 was utilized for the analysis. The groups were compared using Chi-square/Fisher’s Exact tests for categorical variables and t-tests for continuous variables. Multivariate analysis was utilized to determine predictors of adverse outcomes. Results: A cohort of 1,146 non-cancer and 382 active cancer patients were included in the study. The LNS subgroup had a higher frequency of active cancer (29.2% vs 19.3%, p < 0.001), higher rates of diabetes (27.0% vs17.8%, p = 0.03) and chronic kidney disease (18.8% vs 11.7%, p = 0.02). They had greater frequencies of abnormal ferritin levels (57.8% vs 42.7%, p < 0.001), CRP levels > 3 mg/L (96.6% vs 90.3%, p < 0.001), and elevated procalcitonin levels > 0.05 ng/mL (71.2% vs 50.1%, p < 0.001). LNS patients had a higher mortality rate (22.3% vs 9.7%, p < 0.001), a higher need for mechanical ventilation (19.3% vs 9.5%, p < 0.001), and intensive care unit (ICU) admission (35.7% vs 19.5%, p < 0.001. Predictors of mortality included LNS (OR = 2.2, 95%CI [1.5-3.2], p < 0.001), an active cancer diagnosis (OR = 1.7, 95% CI [1.2-2.6], p = 0.003), chronic kidney disease (OR = 1.8 95%CI [1.3-2.5], p = 0.004) and concurrent bacterial pneumonia (OR = 4.9 95%CI [3.3-7.2], p < 0.001). Conclusions: In patients with COVID-19, those with LNS had higher rates of co-morbid conditions including active cancer, higher rates of elevated inflammatory markers, mechanical ventilation, ICU admission, and mortality. Predictors of mortality included concurrent bacterial pneumonia, cancer diagnosis and chronic kidney disease, with LNS increasing the risk of mortality by more than two-fold. These results support the recommendation of early nutritional assessment and a multi-disciplinary approach to aggressive nutritional support in the COVID-19 patient population particularly in those with a concurrent high-risk condition such as cancer.