The Relationship Between Malnutrition Risk and Prognosis in Geriatric Patients Hospitalized for COVID-19

Year 2021, , 382 - 390, 05.09.2021

Beytullah Güner , Ridvan Sivritepe , Sema Uçak Basat

https://doi.org/10.26453/otjhs.892552

Abstract

Objective: We evaluated the effect of nutritional status on the prognosis of the disease in geriatric patients hospitalized due to COVID-19 disease.

Materials and Methods: 110 patients over 65 years old were included. Malnutrition risk was assessed by Nutritional Risk Screening 2002 (NRS 2002). The patients were divided into two groups according to the NRS 2002 score (≥3 as group-1, <3 as group-2). Prognosis markers of the patients were recorded. Statistical significance level was set at p<0.05.

Results: The study was conducted 110 patients (Man/Woman:51/59). In group-1, duration of hospitalization, tomography involvement, intubation rate and referral to intensive care, respiratory rate, leukocyte count, C reactive protein (CRP), ferritin, d-dimer levels were higher than group-2 (p<0.05). In group 1; 35 cases were discharged, 18 cases were transferred to 1st level intensive care, and 2 cases were transferred to 3rd level intensive care. In the group 2, 53 cases were discharged, and 2 cases were transferred to 1st level intensive care unit. There was a significant positive correlation between NRS 2002 score and age, respiratory rate, leukocyte, CRP, d dimer and days of hospitalization score (p<0.05).

Conclusion: Malnourished patients have higher poor prognostic markers, longer hospital stay and more intensive care needs.  

Keywords

COVID-19, geriatrics, malnutrition risk, NRS 2002

COVID-19 Nedeniyle İnterne Edilen Geriatrik Hastalarda Malnütrisyon Riski ile Prognoz Arasındaki İlişki

Abstract

Amaç: Çalışmamızda COVID-19 hastalığı nedeniyle hastaneye yatırılan geriatrik hastalarda nutrisyon durumunun hastalığın prognozuna olan etkisini değerlendirdik.

Materyal ve Metot: Bu prospektif tek merkezli çalışmaya pandemi servisimize yatırılan 65 yaş üstü 110 COVID-19 tanılı hasta dâhil edildi. Malnutrisyon riski Nutrityonel Risk Taraması 2002 (NRS 2002) ile değerlendirildi. Hastalar NRS 2002 skoruna göre ≥3 puan (1. grup) ve <3 puan (2. grup) olacak şekilde iki gruba ayrıldı. Hastaların prognoz belirteçleri kaydedildi. Tüm bu parametreler bu iki grup arasında değerlendirildi. İstatistiksel anlamlılık düzeyi p<0,05 olarak belirlendi.

Bulgular: Çalışmaya toplam 110 hasta (Erkek/Kadın:51/59) dahil edildi. 1.grupta yatış süresi, tomografi tutulumu, entübasyon ve yoğun bakıma sevk oranları, lökosit, C reaktif proteini (CRP), ferritin, d-dimer düzeyleri 2. gruba göre daha yüksekti (p<0,05). 1.gruptaki 35 olgu taburcu, 18 olgu 1. basamak yoğun bakıma sevk, 2 olgu 3. basamak yoğun bakıma sevk edildi. 2. Grupta ise 53 olgu taburcu, 2 olgu 1. basamak yoğun bakıma sevk edildi. NRS2002 skoru ile yaş, solunum sayısı, lökosit, üre, kreatinin, CRP, d-dimer ve yattığı gün sayısı arasında pozitif yönde anlamlı bir ilişki saptandı (p<0,05).

Sonuç: COVID-19 tanısı ile hastaneye yatırılan geriatrik hastalarda nutrisyonel durumun hastalığın prognozunu etkilediğini gösterdik. Malnütre hastaların prognostik belirteçleri daha kötü, hastanede yatış süresi daha uzundur ve yoğun bakım ihtiyacı belirgin olarak artmıştır.

Keywords

Covid-19, geriatri, malnütrisyon, NRS 2002

References

• Sohrab SS, Suhail M, Kamal MA, et al. The Emergence of Human Pathogenic Coronaviruses: Lectins as Antivirals for SARS-CoV-2. Curr Pharm Des. 2020;26(41):5286-5292. doi:10.2174/1381612826666200821120409
• Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. Methods Mol Biol. 2015;1282:1‐23. doi:10.1007/978-1-4939-2438-7_1
• Zhao S, Lin Q, Ran J, et al. Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak. Int J Infect Dis. 2020;92:214-217. doi:10.1016/j.ijid.2020.01.050
• World Health Organization. Novel Coronavirus – Japan (exChina); 2020. https://www.who.int/csr/don/16-january-2020-novel-coronavirus-japan-ex-china/en/. Accessed date 16 January 2020.
• Worldometer. Coronavirus Cases; 2021. https://www.worldometers.info/coronavirus/. Accessed date May 2021.
• Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 Cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242. doi:10.1001/jama.2020.2648
• Ji Y, Ma Z, Peppelenbosch MP, Pan Q. Potential association between COVID-19 mortality and health-care resource availability. Lancet Glob Health. 2020;8(4):e480. doi:10.1016/S2214-109X(20)30068-1
• Lazaridis II, Kraljević M, Schneider R, et al. The Impact of the COVID-19 pandemic on bariatric surgery: Results from a Worldwide Survey. Obes Surg. 2020;30(11):4428-4436. doi:10.1007/s11695-020-04830-8
• Saunders J, Smith T. Malnutrition: causes and consequences. Clin Med. 2010;10(6):624. doi:10.7861/clinmedicine.10-6-624
• Kondrup J, Rasmussen HH, Hamberg OLE, et al. ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321-336. doi:10.1016/s0261-5614(02)00214-5
• Saunders J, Smith T, Stroud M. Malnutrition and undernutrition. Medicine. 2010;39(1):45-50. doi: https://doi.org/10.1016/j.mpmed.2010.10.007
• Song W, Gui M, Wang X, Xiang Y. Cryo-EM structure of the SARS coronavirus spike glycoprotein in complex with its host cell receptor ACE2. PLoS Pathog. 2018;14(8):1-19. doi:10.1371/journal.ppat.1007236
• Xu X, Chen P, Wang J, et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci. 2020;63:1-4. doi:10.1007/s11427-020-1637-5
• Martín-Palmero Á, Serrano-Pérez A, Chinchetru-Ranedo M, et al. Malnutrition in hospitalized patients: results from La Rioja. Nutr Hosp. 2017;34(2):402-406. doi:10.20960/nh.458
• Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27(1):5-15. doi:10.1016/j.clnu.2007.10.007
• Matthay MA, Aldrich JM, Gotts JE. Treatment for severe acute respiratory distress syndrome from COVID-19. Lancet Respir Med. 2020;8:433-434. doi:10.1016/S2213-2600(20)30127-2
• Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-513. doi:10.1016/S0140-6736(20)30211-7
• Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/NEJMoa2002032
• Chu KH, Tsang WK, Tang CS, et al. Acute renal impairment in coronavirus-associated severe acute respiratory syndrome. Kidney Int. 2005;67(2):698-705. doi:10.1111/j.1523-1755.2005.67130.x
• Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020. doi:10.1093/cid/ciaa248
• Lippi G, Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. Clin Chim Acta. 2020;505:190-191. doi:10.1016/j.cca.2020.03.004
• Luo X, Zhou W, Yan X, et al. Prognostic value of C-reactive protein in patients with coronavirus 2019. Clin Infect Dis. 2020;71(16):2174-2179. doi:10.1093/cid/ciaa641
• Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054. doi:10.1016/S0140-6736(20)30566-3