Prognostic role of nutritional status in elderly patients hospitalized for COVID-19: a monocentric study

Abstract

Background Symptomatic severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection incidence is higher in the elderly patients. Pre-existing geriatric conditions such as comorbidity and frailty seem related to worse hospital outcomes. Aims To assess the role of nutritional status as an independent prognostic factor for in-hospital death in elderly patients. Methods Consecutive elderly patients (age > 65 years) hospitalized for novel coronavirus disease (COVID-19) were enrolled. Demographics, laboratory and comorbidity data were collected. Nutritional status was evaluated using the Geriatric Nutritional Risk Index (GNRI). Uni- and multivariate Cox regression analyses to evaluate predictors for in-hospital death were performed. Results One hundred and nine hospitalized elderly patients (54 male) were consecutively enrolled. At univariate analysis, age (HR 1.045 [CI 1.008–1.082]), cognitive impairment (HR 1.949 [CI 1.045–3.364]), C-reactive protein (HR 1.004 [CI 1.011–1.078]), lactate dehydrogenases (HR 1.003 [CI 1.001–1.004]) and GNRI moderate–severe risk category (HR 8.571 [CI 1.096–67.031]) were risk factors for in-hospital death, while albumin (HR 0.809 [CI 0.822–0.964]), PaO2/FiO2 ratio (HR 0.996 [CI 0.993–0.999]) and body mass index (HR 0.875 [CI 0.782–0.979]) were protective factors. Kaplan–Meier survival curves showed a significative higher survival in patients without GNRI moderate or severe risk category (p = 0.0013). At multivariate analysis, PaO2/FiO2 ratio (HR 0.993 [CI 0.987–0.999], p = 0.046) and GNRI moderate–severe risk category (HR 9.285 [1.183–72.879], p = 0.034) were independently associated with in-hospital death. Conclusion Nutritional status assessed by GNRI is a significative predictor of survival in elderly patients hospitalized for COVID-19. The association between GNRI and PaO2/FiO2 ratio is a good prognostic model these patients.

Serum albumin concentrations are associated with disease severity and outcomes in coronavirus 19 disease (COVID-19): a systematic review and meta-analysis

“…Three studies were prospective [ 29 , 41 , 52 ], 51 retrospective [ 20 – 28 , 30 – 34 , 36 – 39 , 42 – 46 , 48 – 51 , 53 , 54 , 57 – 60 , 62 , 63 , 65 , 66 , 69 – 76 , 78 , 80 , 81 , 83 – 86 ], while 13 did not specifically declare the study design [ 23 , 35 , 40 , 47 , 55 , 56 , 61 , 64 , 67 , 68 , 77 , 79 , 82 ]. Fifty-two studies (77.6%) were performed in China [ 22 , 24 – 26 , 28 – 31 , 33 – 35 , 37 – 43 , 46 – 57 , 59 , 62 – 64 , 68 – 85 ] while the remaining 15 were conducted in the rest of the world [ 20 , 21 , 23 , 27 , 32 , 36 , 44 , 45 , 58 , 60 , 61 ...…”

COVID-19 im Alter – Die geriatrische Perspektive

“…Dabei erhöht das Vorliegen einer Mangelernährung eindeutig das Risiko für einen schweren bzw. tödlichen Verlauf einer COVID-19-Erkrankung [ 54 ]. Dass eine Mangelernährung auch das Risiko für das Auftreten einer SARS-CoV-2-Infektion erhöht, wird vermutet, ist aber bisher nicht bewiesen.…”

Nutritional and Behavioral Approaches to Body Composition and Low-Grade Chronic Inflammation Management for Older Adults in the Ordinary and COVID-19 Times

“…Currently, some studies are reporting on the nutritional status of older patients affected by COVID-19, as it may serve as a prognostic tool for their recovery. In that line, Racinella et al examined the nutritional status of over 100 men and women (≥65 years) hospitalized for COVID-19 and reported that their Geriatric Nutrition Risk Index was a significant predictor for survival, even after some confounders were taken into account [ 25 ]. Importantly, in one of the earlier studies conducted in Wuhan elderly patients ( n = 182), 52.7% were diagnosed with malnutrition (via Mini Nutritional Assessment) and also characterized as having diabetes, a smaller calf circumference and lower serum albumin, placing them at disadvantageous outcomes in infection recovery [ 26 ].…”