Impact of severe SARS-CoV-2 infection on nutritional status and subjective functional loss in a prospective cohort of COVID-19 survivors

Abstract

The nutritional sequelae of COVID-19 have not been explored in a large cohort study.ObjectivesTo identify factors associated with the change in nutritional status between discharge and 30 days post-discharge (D30). Secondary objectives were to determine the prevalence of subjective functional loss and severe disability at D30 and their associated factors.MethodsCollected data included symptoms, nutritional status, self-evaluation of food intake, Performance Status (PS) Scale, Asthenia Scale, self-evaluation of strength (SES) for arms and legs at discharge and at D30. An SES <7 was used to determine subjective functional loss. A composite criteria for severe disability was elaborated combining malnutrition, subjective functional loss and PS >2. Patients were classified into three groups according to change in nutritional status between discharge and D30 (persistent malnutrition, correction of malnutrition and the absence of malnutrition).ResultsOf 549 consecutive patients hospitalised for COVID-19 between 1 March and 29 April 2020, 130 died including 17 after discharge (23.7%). At D30, 312 patients were at home, 288 (92.3%) of whom were interviewed. Of the latter, 33.3% were malnourished at discharge and still malnourished at D30, while 23.2% were malnourished at discharge but no longer malnourished at D30. The highest predictive factors of persistent malnutrition were intensive care unit (ICU) stay (OR=3.42, 95% CI: 2.04 to 5.75), subjective functional loss at discharge (OR=3.26, 95% CI: 1.75 to 6.08) and male sex (OR=2.39, 95% CI: 1.44 to 3.97). Subjective functional loss at discharge (76.8%) was the main predictive factor of subjective functional loss at D30 (26.3%) (OR=32.6, 95% CI: 4.36 to 244.0). Lastly, 8.3% had a severe disability, with a higher risk in patients requiring an ICU stay (OR=3.39, 95% CI: 1.43 to 8.06).ConclusionPatients who survived a severe form of COVID-19 had a high risk of persistent malnutrition, functional loss and severe disability at D30. We believe that nutritional support and rehabilitation should be strengthened, particularly for male patients who were admitted in ICU and had subjective functional loss at discharge.Trial registration numberNCT04451694.

Long-Term Evolution of Malnutrition and Loss of Muscle Strength after COVID-19: A Major and Neglected Component of Long COVID-19

“…As reported previously [17], 13.2% of the patients hospitalized for a severe form of COVID-19 were still severely malnourished 30 days after hospital discharge (weight loss > 10% and/or BMI < 17). The highest predictive factors of persistent malnutrition were ICU stay and male sex.…”

“…In view of the latter, we found it useful to use a selfevaluation muscle strength scale, asking the patient how he/she rated his/her muscle strength compared to before the disease. In a preliminary study, we found a concordance between the outcome of this subjective functional evaluation (Self Evaluation of Strength (SES)) and that of the grip test [17].…”

“…The strong point of such evaluation is to assess muscle function in the long term and to judge the evolution of muscle strength, without knowledge of the level of strength prior to the disease. We evaluated this tool in a small cohort of hospitalized patients [17] and while we were unable to identify the actual threshold of functional impairment, our assessment was nevertheless based on the threshold determined according to the questionnaire of Krznaric et al [14] and on other subjective visual or numeric scales [40]. This threshold must, however, be validated in a large cohort study, notably in comparison with the evolution of muscle strength objectively measured by dynamometry.…”

Impact of COVID-19 Infection and Persistent Lingering Symptoms on Patient Reported Indicators of Nutritional Risk and Malnutrition

“…Participants in our study were, on average, over 3 months post-positive-COVID-19 infection and fell into the long-COVID category. However, most research to date looking at malnutrition or malnutrition risk post-COVID-19 infection has had a short follow-up time of one month or less [ 11 , 21 , 22 ]. A study by Bedock et al followed 91 patients hospitalized for COVID-19 infection during admission and 30 days post-discharge and found that 28.6% of patients were malnourished, based on the Global Leadership Initiative on Malnutrition (GLIM) criteria, 30 days after discharge [ 21 ].…”

“…A study by Bedock et al followed 91 patients hospitalized for COVID-19 infection during admission and 30 days post-discharge and found that 28.6% of patients were malnourished, based on the Global Leadership Initiative on Malnutrition (GLIM) criteria, 30 days after discharge [ 21 ]. Similarly, another study of 288 patients hospitalized for COVID-19 found that 33.3% of patients were malnourished based on GLIM criteria at 30 days after discharge [ 22 ]. In contrast, Filippo et al used the Mini Nutritional Assessment (MNA) to assess for malnutrition and found that 54.7% of patients were at risk for malnutrition, but only 6.6% were malnourished when evaluated in an outpatient clinic at a median of 23 days post-discharge for COVID-19 infection [ 11 ].…”