Nutritional parameters and clinical outcomes of patients admited with COVID-19 in a university hospital

Ribeiro, Jéssica Francisca Soares; Arruda, Ilma Kruze Grande de; Tomiya, Marília Tokiko Oliveira; Branco, Eduarda Silva de Castello; Solon, Lilian Andrade; Dutra, Tauane Alves

doi:10.1590/1678-9865202336e220215

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Sumário

ORIGINAL | Clinical Nutrition • Rev Nutr 36 • 2023 • https://doi.org/10.1590/1678-9865202336e220215 copy

Nutritional parameters and clinical outcomes of patients admited with COVID-19 in a university hospital

Parâmetros nutricionais e desfechos clínicos de pacientes admitidos com COVID-19 em um hospital universitário

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To evaluate the relationship between nutritional parameters and clinical factors and the outcome of patients diagnosed with COVID-19.

Methods

This is a prospective longitudinal study involving patients with COVID-19 infection admitted to a University Hospital in Pernambuco. The sample consisted of individuals aged ≥20 years who tested positive for COVID-19 infection. Nutritional risk was assessed using the recommended screening procedure for this group and the nutritional status using the Body Mass Index. Demographic and clinical variables were transcribed from the medical records.

Result

There was a predominance of adult inpatients between 20 and 59 years of age (95% CI: 64.6-76.0); nutritional risk was observed in 91.6% of patients and overweight in 58.9% of patients. Age ≥60 years (p=0.03), presence of malignancies and inadequate nutrition (p<0.001) were independent risk factors for in-hospital death. It was also observed that only arterial hypertension (OR 2.34, 95% CI 1.32-4.13, p=0.003) and overweight (OR 1.84, 95% CI 1.05-3.21, p=0.032) were considered independent risk factors for admission of the patients in the Intensive Care Unit.

Conclusion

Although overweight is a risk factor for admission in the Intensive Care Unit, it was not possible to observe it as a factor for mortality, requiring further studies to determine the mechanisms that interfere in the association between obesity and mortality in those patients.

Keywords
COVID-19; Nutritional assessment; Nutritional status

Characteristics		n	%	95% CI
Gender
	Male	128	51.2	45.0-57.4
	Female	122	48.8	42.6-55.0
Age
	20 to 59 years	175	70.3	64.6-76.0
	≥ 60 years	74	29.7	24.0-35.4
Comorbidities
	Diabetes mellitus	81	32.5	26.7-38.5
	Systemic Arterial Hypertension	148	59.4	53.3-65.5
	Chronic Kidney Disease	21	8.4	5.0-11.9
	Cancer	36	14.5	10.1-18.8
	No comorbidities	25	10.0	6.3-13.8
Body Mass Index upon admission
	Malnutrition	27	9.2	7.0-14.8
	Eutrophy	78	31.9	25.7-37.2
	Overweight	146	58.9	52.7-65.0
Nutritional Risk
	Yes	229	91.6	88.2-95.0
	No	21	8.4	5.0-11.8
Feeding route
	Oral	239	97.2	95.1-99.2
	Enteral	11	4.5	1.9-7.0
	Parenteral	-	-	–
Adequate nutritional support
	Yes	206	85.1	80.6-89.6
	No	36	14.9	10.4-19.4
Clinical outcome
	Release	229	91.6	87.5-94.4
	Death	21	8.4	5.5-12.5
ICU admission
	Yes	83	33.3	27.6-39.2
	No	167	66.7	60.7-72.3
		Median (IQ)
Days in intensive care unit		8 (3-15)

Variables		Crude analysis			Adjusted analysis
Variables		Hazard Ratio	95% CI	p ^a a Cox regression;	Hazard Ratio	95% CI	p ^b b Cox regression adjusted for body mass index. CI: confidence interval; HR: hazard ratio.
Age
	18-59 years	1			1
	≥60 years	3.51	1.45-8.50	0.005	2.64	1.10-7.48	0.032
Cancer
	No	1			1
	Yes	4.43	1.79-10.96	0.001	2.24	1.16-9.04	0.025
Adequate nutritional intake
	Yes	1			1
	No	7.48	3.00-18.64	<0.001	7.09	2.75-18.27	<0.001

Variables		Intensive Care Unit				p ^* * Chi-square test.
		Yes		No
		n	%	n	%
Age
	Adult	59	33.9	115	66.1	0.775
	Older adults	23	31.1	51	68.9
Gender
	Female	38	31.4	83	68.6	0.622
	Male	45	35.2	83	64.8
Systemic Arterial Hypertension
	Yes	60	40.8	87	59.2	0.005
	No	23	22.8	78	77.2
Chronic Kidney Disease
	Yes	11	52.4	10	47.6	0.093
	No	72	31.7	115	68.3
Cancer
	Yes	9	25.0	27	75.0	0.330
	No	74	34.9	138	65.1
Nutritional risk
	Yes	76	33.3	152	66.7	1.000
	No	7	33.3	14	66.7
Adequate nutritional intake
	Yes	71	34.5	135	65.5	0.553
	No	10	27.8	26	72.2
Body mass index
	Without overweight	26	25.5	76	74.5	0.043
	Overweight	56	38.6	89	61.4

Variables		Crude OR			Adjusted OR
Variables		OR	95% CI	^* * Odds ratio. Multivariate logistic regression model: systemic arterial hypertension, chronic kidney disease and body mass index. CI: Confidence Interval. p	OR	95% CI	p
Systemic Arterial Hypertension
	Yes	2.34	1.32-4.13	0.003	1.95	1.08-3.54	0.026
	No	1			1
Chronic Kidney Disease
	Yes	2.37	0.96-5.83	0.061	2.60	1.00-6.77	0.050
	No	1			1
Body mass index
	Overweight	1.84	1.05-3.21	0.032	1.82	1.00-3.31	0.049
	Without overweight	1			1

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[1] Correspondence to: MTO TOMIYA. E-mail: mariliatokiko@gmail.com.