What is the predictive value of the prognostic nutritional index for the severity of COVID-19 hospitalized patients ?

Yıl 2022, Cilt: 8 Sayı: 4, 481 - 489, 30.11.2022

Derya Yenibertiz Deniz Güven Filiz Koç Mehmet Enes Gökler Faruk Bolu Hakan Buluş

https://doi.org/10.19127/mbsjohs.1114583

Öz

Objective: Malnutrition is a risk factor for severe coronavirus disease 2019 (COVID-19) and early nutritional
risk assessment should be performed consistently and promptly to determine the proper nutritional therapy
and lead to a good prognosis. We aimed to investigate the predictive value of the prognostic nutritional index
(PNI) in determining the severity of hospitalized COVID-19 patients.
Methods: In this retrospective single-center research, a total of 686 hospitalized adult patients with COVID19 between April 2020-June 2020 were analyzed. Demographic, clinical, radiological and laboratory data
were registered from patient files. Nutritional status was evaluated using the BMI and PNI. Patients were
divided into three groups according to PNI values: severe (PNI ≤ 35), moderate (35(PNI≥38).
Results: The study group's average PNI score was 35.56 ± 4.58.PNI values were found to be normal in 37.3
percent (N: 256) of the patients, moderate in 28.3 percent (N: 194), and severe in 34.4 percent (N: 236). Male
patients, those over the age of 65, referred patients, intubated patients, and those who died were at a higher
risk of severe PNI. Patients with normal computed tomography scans were found to have a higher incidence
in the normal PNI. The length of hospitalization increased in proportion to the severity of PNI. As the severity
of the PNI category increased, so did albumin, C reactive protein, D-dimer, ferritin, lactate dehydrogenase,
and neutrophil levels. The total protein value decreased, as the severity of the PNI category increased.
Conclusion: PNI can be determined easily and quickly using routine blood tests and it can be useful for early
detection of potentially fatal illnesses, giving medical care and improving prognosis.

Anahtar Kelimeler

COVID 19, malnutrition, Prognostic Nutritional Index, prognosis

Kaynakça

• 1. World Health Organisation. Weekly epidemiological update on Coronavirus disease 2019. 21 December 2021.Available from:https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19-21-december-2021
• 2. Weiss P, Murdoch DR. Clinical course and mortality risk of severe COVID-19. Lancet Lond Engl. 2020;395:1014–1015.
• 3. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet Lond Engl. 2020; 395:497–506.
• 4. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323:1061–9.
• 5. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China descriptive study. Lancet Lond Engl. 2020;395:507–513.
• 6. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020;395:1054–1062.
• 7. Peter K. Katona-Apte J. The interaction between nutrition and infection. Clin Infect Dis. 2008;May15;46(10):1582-1588.
• 8. Xue G, Gan X, Wu Z, Xie D, Xiong Y, Hua L et al. Novel serological biomarkers for inflammation in predicting disease severity in patients with COVID-19. Int Immunopharmacol.2020;89(Pt A): 107065.
• 9. Ahn SS, Yoo J, Jung SM, Song JJ, Park YB, Lee SW. Comparison of the Clinical Implications among Five Different Nutritional Indices in Patients with Lupus Nephritis. Nutrients. 2019;11(7):1456.
• 10. Zabetakis I, Lordan R, Norton C, Tsoupras A. COVID-19: The Inflammation Link and the Role of Nutrition in Potential Mitigation. Nutrients. 2020;19;12(5):1466.
• 11. Caccialanza R, Laviano A, Lobascio F, Montagna E, Bruno R, Ludovisi Set. al. Early nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): Rationale and feasibility of a shared pragmatic protocol. Nutrition. 2020;74: 110835.
• 12. Azzolino D, Saporiti E, Proietti M, Cesari M. Nutritional Considerations in Frail Older Patients with COVID-19. J Nutr Health Aging. 2020;24(7):696-698.
• 13. Rashedi S, Keykhaei M, Pazoki M, Ashraf H, Najafi A, Kafan S et.al. Clinical significance of prognostic nutrition index in hospitalized patients with COVID-19: Results from single-center experience with systematic review and meta-analysis. Nutr Clin Pract. 2021;36(5):970-983.
• 14. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi. 1984;85:1001–1005.
• 15. Wang R, He M, Yin W, Liao X, Wang B, Jin X et. al. The Prognostic Nutritional Index is associated with mortality of COVID-19 patients in Wuhan, China. J Clin Lab Anal. 2020;34(10):e23566.
• 16. Hu X, Deng H, Wang Y, Chen L, Gu X, Wang X. Predictive value of the prognostic nutritional index for the severity of coronavirus disease 2019. Nutrition. 2021; 84:111123.
• 17. Wang ZH, Lin YW, Wei XB, Li F, Liao XL, Yuan HQ et. al. Predictive Value of Prognostic Nutritional Index on COVID-19 Severity. Front Nutr. 2021;14;7:582736.
• 18. Wei W, Wu X, Jin C, Mu T, Gu G, Min Met. al. Predictive Significance of the Prognostic Nutritional Index (PNI) in Patients with Severe COVID-19. J Immunol Res. 2021; 2021:9917302.
• 19. Hu X, Deng H, Wang Y, Chen L, Gu X, Wang X. Predictive value of the prognostic nutritional index for the severity of coronavirus disease 2019. Nutrition. 2021; 84:111123.
• 20. Çınar T, Hayıroğlu Mİ, Çiçek V, Kılıç Ş, Asal S, Yavuz Set. al. Is prognostic nutritional index a predictive marker forestimating all-cause in-hospital mortality in COVID-19 patients with cardiovascular risk factors? Heart Lung. 2021;50(2):307-312.
• 21. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.Lancet.2004;363(9403):157-163.
• 22. Arabi YM, Murthy S, Webb S. COVID-19: a novel coronavirus and a novel challenge for criticalcare. Intensive Care Med. 2020;46(5):833-836.
• 23. Zhao X, Li Y, Ge Y, Shi Y, Lv P, Zhang J et. al. Evaluation of Nutrition Risk and Its Association with Mortality Risk in Severely and Critically Ill COVID-19 Patients. JPEN J Parenter Enteral Nutr. 2021;45(1):32-42.
• 24. Lidoriki I, Frountzas M, Schizas D. Could nutritional and functional status serve as prognostic factors for COVID-19 in the elderly? Med Hypotheses. 2020;144: 109946.
• 25. Bresnahan KA, Tanumihardjo SA. Undernutrition, the acute phase response to infection, and its effects on micronutrient status indicators. Adv Nutr. 2014;5(6):702-711.
• 26. Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y et. al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020;146(1):110-118.
• 27. O' Driscoll M, Ribeiro Dos Santos G, Wang L, Cummings DAT, Azman AS, Paireau J et al. Age-specific mortality and immunity patterns of SARS-CoV-2. Nature. 2021;590(7844):140-145.
• 28. Yang W, Kandula S, Huynh M, Greene SK, Van Wye G, Li W et. al. Estimating the infection-fatality risk of SARS-CoV-2 in New York City during the spring 2020 pandemic wave: a model-based analysis. Lancet Infect Dis. 2021;21(2):203-212.
• 29. Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai Net. al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669-677.
• 30. Gebhard C, Regitz-Zagrosek V, Neuhauser HK, Morgan R, Klein SL. Impact of sex and gender on COVID-19 outcomes in Europe. Biol Sex Differ. 2020;11(1):29.
• 31. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A et. al. COVID-19 Lombardy ICU Network. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-1581.
• 32. Xue G, Gan X, Wu Z, Xie D, Xiong Y, Hua L et. al. Novel serological biomarkers for inflammation in predicting disease severity in patients with COVID-19. Int Immunopharmacol. 2020;89(PtA):107065.
• 33. Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan Jet. al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020;63(3):364-374.
• 34. Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR, and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504.
• 35. Liu S, Luo H, Wang Y, Cuevas LE, Wang D, Ju Set. al. Clinical characteristics and risk factors of patients with severe COVID-19 in Jiang suprovince, China: a retrospective multicentre cohort study. BMC Infect Dis. 2020;20(1):584.
• 36. Luo Y, Xue Y, Mao L, Yuan X, Lin Q, Tang G et al. Prealbumin as a Predictor of Prognosis in Patients with Coronavirus Disease 2019. Front Med (Lausanne). 2020; 7:374.
• 37. Mattiuzzi C, Lippi G. Serum prealbumin values predict the severity of coronavirus disease 2019 (COVID-19). J MedVirol. 2021;93(2):620-621.
• 38. Violi F, Cangemi R, Romiti GF, Ceccarelli G, Oliva A, Alessandri F et. al. Is Albumin Predictor of Mortality in COVID-19? Antioxid Redox Signal. 2021;35(2):139-142.
• 39. Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: Pathogenesis and Clinical Significance. JPEN J Parenter Enteral Nutr. 2019; 43(2):181-193.
• 40. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu Set. al. Risk Factors Associated with Acute Respiratory Distress Syndrome and Death in Patients with Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-943.
• 41. Miyashita E, Konuma T, Kataoka J, Oiwa-Monna M, Mizusawa M, Isobe M.et al. The Prognostic Impact of Pretransplant Inflammatory and Nutritional Status in Adult Patients after Myeloablative Single Cord Blood Transplantation. Biol Blood Marrow Transplant. 2019;25(5):981-988.
• 42. Mo P, Xing Y, Xiao Y, Deng L, Zhao Q, Wang Het. al. Clinical Characteristics of Refractory Coronavirus Disease 2019 in Wuhan, China. Clin Infect Dis. 2021; 73(11):e4208-e13.