Malnutrition: Percentage and Association with Prognosis in Patients Hospitalized for Coronavirus Disease 2019.

Olivier Bouchaud,Lucie Allard,Bénédicte Giroux-Leprieur,Morgane Didier,David Deutsch,Helene Bihan,Constant Josse,Angela Sutton,Emmanuel Cosson,Camille Baudry,Julie Molleville,Elise Ouedraogo

doi:10.3390/nu12123679

Abstract

Previous studies have found a correlation between malnutrition and prognosis in respiratory infections. Our objectives were to determine (i) the percentage of malnutrition, and (ii) its prognosis in patients admitted for coronavirus disease 2019 (COVID-19). In this monocentric retrospective study, we consecutively included all adult patients presenting with acute COVID-19 between 9 April and 29 May 2020. Malnutrition was diagnosed on low body mass index (BMI) and weight loss ≥ 5% in the previous month and/or ≥ 10% in the previous six months. The Nutritional Risk Index (NRI) defined nutritional risk. Severe COVID-19 was defined as a need for nasal oxygen ≥ 6 L/min. We enrolled 108 patients (64 men, 62 ± 16 years, BMI 28.8 ± 6.2 kg/m2), including 34 (31.5%) with severe COVID-19. Malnutrition was found in 42 (38.9%) patients, and moderate or severe nutritional risk in 83 (84.7%) patients. Malnutrition was not associated with COVID-19 severity. Nutritional risk was associated with severe COVID-19 (p < 0.01; p < 0.01 after adjustment for C reactive protein), as were lower plasma proteins, albumin, prealbumin, and zinc levels (p < 0.01). The main cause of malnutrition was inflammation. The high percentage of malnutrition and the association between nutritional risk and COVID-19 prognosis supports international guidelines advising regular screening and nutritional support when necessary.

Highlights

In clinical practice, coronavirus disease 2019 (COVID-19) could be associated with a high prevalence of malnutrition as a consequence of severe acute inflammatory status and decreased appetite, resulting in a negative nutritional balance [1]
Malnutrition might be a prognostic factor for COVID-19–related increased morbidity and mortality [9], and guidelines have been issued about the need for nutritional support [1,10,11,12,13,14]
On the contrary and in agreement with previous COVID-19 studies [3,4,5,6,7,8], we found an independent association between age, initial infection presentation, inflammatory biomarkers, and infection severity, suggesting that the poor prognosis associated with nutritional risk is partly driven by inflammation [30]

Summary

Introduction

Coronavirus disease 2019 (COVID-19) could be associated with a high prevalence of malnutrition as a consequence of severe acute inflammatory status and decreased appetite, resulting in a negative nutritional balance [1]. Several risk factors for severe COVID-19 pneumonia have been identified, including older age, male gender, and metabolic comorbidities [3,4,5,6,7,8]. Our objectives were to establish (i) the percentage of malnutrition in patients admitted in COVID-19 units (excluding intensive care units (ICU)) and (ii) the prognostic value of malnutrition parameters. Nutritional risk was associated neither with food intake nor with digestive symptoms, but was associated with age and with higher levels of several inflammatory biomarkers, including orosomucoid, fibrinogen, CRP, and procalcitonin (Table 3), even after adjustment for age (procalcitonin, p = 0.01; orosomucoid, p = 0.02; fibrinogen and CRP, p < 0.01).

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