Evaluation of the effectiveness of the Nutritional Risk Screening System 2002 (NRS‐2002) in COVID‐19 patients admitted to the intensive care unit

Abstract

Background Nutritional status of patients with COVID‐19 can affect the recovery process of patients; however, no nutritional scale was introduced to evaluate the nutritional status of the patients. Thus, the main objective of this study was to examine the usefulness of Nutritional status‐2002 (NRS‐2002) among COVID‐19 patients admitted to the intensive care unit (ICU). Material and Methods In this cross‐sectional study, 73 patients with definitive corona diagnosis admitted to the ICUs of Al‐Zahra hospital, Isfahan, Iran in October 2020 to January 2021 were recruited. Dietary intake, NRS‐2002, demographic, anthropometric and biochemical indices of patients were recorded. Results The majority of patients were at risk for moderate (69.9%) to severe (12.3%) malnutrition. Daily calorie intake ( P = .001) and albumin ( P = .001) levels in deceased patients were significantly lower than the recovered group. A direct correlation between NRS‐2002 and age ( P < .001) and an inverse correlation with daily calorie intake ( P = .002), albumin ( P = .05) and PaO2 ( P = .034) was found. Moreover, there is a strong correlation between NRS‐2002 score and chance of death among COVID‐19 patients (OR=34.5, 95%CI:(5.2 ‐ 228.93), P‐value<0.001). Likewise, the levels of bilirubin direct (OR=8, 95%CI:(1.30 ‐ 49.38), P‐value=0.025) and creatine‐phosphokinase (OR=0.9, 95%CI:(0.99 ‐ 1.00), P‐value=0.035) have a significant direct association with chance of death. Conclusion Results showed patients with COVID‐19 admitted to the ICU did not have appropriate nutritional status and mortality was higher among patients with lower amounts of the serum albumin and daily calorie intakes. Furthermore, there is a strong association between the NRS‐2002 index and the chance of mortality in these patients.

Association of Prognostic Nutritional Index with Severity and Mortality of Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

“…In an attempt to identify prognostic markers for COVID-19 severity and mortality, a previous study suggested a better predictive outcome when combining indicators of inflammation with those of nutritional status than that from inflammation biomarkers alone [ 31 ]. The association of malnutrition with a poor prognosis in patients with COVID-19 has been reflected in the finding of a previous study, in which patients with COVID-19 who were admitted to ICU were found to be at risk for moderate (69.9%) to severe (12.3%) malnutrition [ 12 ]. Several factors have been reported to contribute to malnutrition in patients infected with COVID-19, including elevated catabolism from fever and exertion of respiratory muscles as well as endocrinological perturbations that lead to accelerated gluconeogenesis, protein breakdown, and lipid oxidation [ 11 ].…”

“…Other reported indicators of disease progression and mortality also included serological biomarkers such as C-reactive protein (CRP), neutrophil–lymphocyte ratio (NLR), ferritin, troponin, and lymphocyte count [ 41 , 42 ]. On the other hand, although several studies demonstrated an association between a poor nutritional status and an elevated risk of in-hospital death in patients infected with COVID-19 [ 11 , 12 ], the pooled evidence between the PNI and prognosis of COVID-19 was rarely investigated. Our finding demonstrated that a low PNI correlated with a seven-fold increased risk of mortality in hospitalized patients with COVID-19.…”

“…Previous studies have demonstrated an association between a poor nutritional status and an elevated risk of in-hospital fatality in patients infected with COVID-19 [ 11 , 12 ]. Prognostic nutritional index (PNI), which can be simply calculated from albumin concentration and lymphocyte count from peripheral blood, has been demonstrated to be significantly associated with the incidence of postoperative complications and mortality rate in patients diagnosed with various gastrointestinal malignancies [ 13 , 14 ].…”

Nutritional factors associated with mortality in hospitalized patients with COVID-19

“…In our study, 78.4% of patients who died were classified as at risk of undernutrition according to NRS 2002. NRS score was associated with the risk of mortality in patients with COVID-19 in other studies [20,21]. In addition, there is scientific evidence that NRS-2002 has an excellent sensitivity in identifying patients with COVID-19 with poor clinical outcomes and is associated with length of hospitalization [22,23] and with an increased risk of loss of appetite [21e23].…”

The relationship of nutritional risk and NRS2002 score with disease progression and prognosis in patients with COVID-19

“…Previous studies have shown that the NRS2002 score can be an appropriate and practical predictor of prognosis for COVID-19 patients [23,39] , an independent predictor of the clinical type of COVID-19 patients [25] , and indirectly re ecting the severity and prognosis of COVID-19 [40] . In this study, the NRS2002 score not only had a signi cant impact on disease progression and prognosis in COVID-19 patients, but also had a good predictive value for both disease severity and prognosis, with cutoff value of 0.5, 5.5, respectively.…”