Factors Associated with Significant Weight Loss in Hospitalised Patients with COVID-19: A Retrospective Cohort Study in a Large Teaching Hospital

Abstract

SARS-CoV-2 infection (COVID-19) is associated with malnutrition risk in hospitalised individuals. COVID-19 and malnutrition studies in large European cohorts are limited, and post-discharge dietary characteristics are understudied. This study aimed to assess the rates of and risk factors for ≥10% weight loss in inpatients with COVID-19, and the need for post-discharge dietetic support and the General Practitioner (GP) prescription of oral nutritional supplements, during the first COVID-19 wave in a large teaching hospital in the UK. Hospitalised adult patients admitted between March and June 2020 with a confirmed COVID-19 diagnosis were included in this retrospective cohort study. Demographic, anthropometric, clinical, biochemical, and nutritional parameters associated with ≥10% weight loss and post-discharge characteristics were described. Logistic regression models were used to identify risk factors for ≥10% weight loss and post-discharge requirements for ongoing dietetic input and oral nutritional supplement prescription. From the total 288 patients analysed (40% females, 72 years median age), 19% lost ≥ 10% of their admission weight. The length of hospital stay was a significant risk factor for ≥10% weight loss in multivariable analysis (OR 1.22; 95% CI 1.08–1.38; p = 0.001). In addition, ≥10% weight loss was positively associated with higher admission weight and malnutrition screening scores, dysphagia, ICU admission, and artificial nutrition needs. The need for more than one dietetic input after discharge was associated with older age and ≥10% weight loss during admission. A large proportion of patients admitted to the hospital with COVID-19 experienced significant weight loss during admission. Longer hospital stay is a risk factor for ≥10% weight loss, independent of disease severity, reinforcing the importance of repeated malnutrition screening and timely referral to dietetics.

Implications of COVID‐19 in Airway and Swallowing Function

“…9 Another study by Zannidi et al assessing weight loss in hospitalized patients found that increased length of stay was an independent risk factor for >10% weight loss in patients. 13 With an average duration of 14.7 ± 16.9 days in our cohort, the ability for oral intake is a significant concern in preventing malnutrition. In-hospital malnutrition can further exacerbate the disease burden and increase mortality.…”

“…This is demonstrated by our finding that NPO status in intubated individuals resulted in a significantly prolonged duration of intubation and ventilation. Zannidi et al study patients with significant weight loss also had markers for worse disease severity including higher rates of oxygen therapy, ICU admission, mechanical ventilation, and dysphagia, in addition to others 13 . Furthermore, a study in France found that even 30 days after discharge patients remained malnourished, which could be predicted by the use of mechanical ventilation while hospitalized 15 .…”

“…In the study performed by Lindh et al, their patients experiencing dysphagia were more likely to be older, have invasive ventilation or tracheostomy longer, and have prolonged ICU and hospital stays 9 . Another study by Zannidi et al assessing weight loss in hospitalized patients found that increased length of stay was an independent risk factor for >10% weight loss in patients 13 . With an average duration of 14.7 ± 16.9 days in our cohort, the ability for oral intake is a significant concern in preventing malnutrition.…”

“…Zannidi et al study patients with significant weight loss also had markers for worse disease severity including higher rates of oxygen therapy, ICU admission, mechanical ventilation, and dysphagia, in addition to others. 13 Furthermore, a study in France found that even 30 days after discharge patients remained malnourished, which could be predicted by the use of mechanical ventilation while hospitalized. 15 Lindh et al found a moderate association between the presence of dysphagia and patient discharge to a home or rehab clinic.…”

Brachial plexopathy as a result of anatomical prone position in COVID‐19 patients—Systematic review

“…Although obesity is well described risk factor of neuropathy, weight loss might also be a contributing factor of this lesion (Brugliera et al, 2021). In a study about factors connected to weight loss in hospitalized patient with COVID-19, authors observed that the length of hospitalization is a significant risk factor of weight decrease (Zannidi et al, 2022), what had been early confirmed (Fiorindi et al, 2021). Thus changes in body weight and hence in fat tissue predispose to nerve injury and plexopathy (Brugliera et al, 2021).…”