Abstract
The COVID-19 pandemic is a public health crisis that has the potential to exacerbate worldwide malnutrition. This study examines whether patients with a history of malnutrition are predisposed to severe COVID-19. To do so, data on 103,099 COVID-19 inpatient encounters from 56 hospitals in the United States between March 2020 and June 2020 were retrieved from the Cerner COVID-19 Dataset. Patients with a history of malnutrition between 2015 and 2019 were identified, and a random intercept logistic regression models for pediatric and adult patients were built controlling for patient demographics, socioeconomic status, admission vital signs, and related comorbidities. Statistical interactions between malnutrition and patient age were significant in both the pediatric [log-odds and 95% confidence interval: 0.094 (0.012, 0.175)] and adult [− 0.014 (− 0.021, − 0.006] models. These interactions, together with the main effect terms of malnutrition and age, imply higher odds for severe COVID-19 for children between 6 and 17 years with history of malnutrition. Even higher odds of severe COVID-19 exist for adults (with history of malnutrition) between 18 and 79 years. These results indicate that the long-term effect of malnutrition predisposes patients to severe COVID-19 in an age-dependent way.
Highlights
Mechanical ventilation was required for 517 of the children and 21 expired with all but 3 having been on a ventilator before death. This resulted in 520 (6.0% of) children being classified as severe COVID-19 patients
Among children with mild COVID-19, 1.5% had a history of malnutrition with incidence significantly increasing to 7.5% among those with severe COVID-19
The multivariable random intercept logistic regression model indicated that malnutrition impacts the predisposition of both children and adults to severe COVID-19 through a statistical interaction with age
Summary
The multivariable random intercept logistic regression model (accounting for heterogeneity across hospitals) indicated that malnutrition impacts the predisposition of both children and adults to severe COVID-19 through a statistical interaction with age. The statistical interaction terms in both the pediatric (p value: 0.0245) and adult (p value: 0.0003) models were significant. This significance implies that the extent of the risk of severe COVID-19 due to malnutrition is dependent on the age of the patient. Graphical interpretation of the interactions between malnutrition and patient age are shown in Figs. 1 and
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