Nutritional Risk Screening and Body Composition in COVID‐19 Patients Hospitalized in an Internal Medicine Ward

Abstract

Rosaria Del Giorno,1,2,* Massimo Quarenghi,3,* Kevyn Stefanelli,4 Silvia Capelli,3 Antonella Giagulli,3 Lara Quarleri,3 Daniela Stehrenberger,3 Nicola Ossola,5 Rita Monotti,6 Luca Gabutti1,2 1Department of Internal Medicine, Clinical Research Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; 2Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland; 3Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland; 4Department of Social Sciences and Economics, Sapienza University of Rome, Rome, Italy; 5Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Mendrisio, Switzerland; 6Department of Internal Medicine, Ospedale La Carità, Locarno, Switzerland*These authors contributed equally to this workCorrespondence: Rosaria Del Giorno Luca GabuttiInstitute of Biomedicine, University of Southern Switzerland, Lugano, SwitzerlandTel [phone]; [phone]Email [email protected]; [email protected]: Malnutrition in patients hospitalized in internal medicine wards is highly prevalent and represents a prognostic factor of worse outcomes. Previous evidence suggested the prognostic role of the nutritional status in patients affected by the coronavirus disease 2019 (COVID-19). We aim to investigate the nutritional risk in patients with COVID-19 hospitalized in an internal medicine ward and their clinical outcomes using the Nutritional Risk Screening 2002 (NRS-2002) and parameters derived from bioelectrical impedance analysis (BIA).Methods: Retrospective analysis of patients with COVID-19 aimed at exploring: 1) the prevalence of nutritional risk with NRS-2002 and BIA; 2) the relationship between NRS-2002, BIA parameters and selected outcomes: length of hospital stay (LOS); death and need of intensive care unit (ICU); prolonged LOS; and loss of appetite.Results: Data of 90 patients were analyzed. Patients at nutritional risk were 92% with NRS-2002, with BIA-derived parameters: 88% by phase angle; 86% by body cell mass; 84% by fat-free mass and 84% by fat mass (p-value ≤ 0.001). In ROC analysis, NRS had the maximum sensitivity in predicting the risk of death and need of ICU and a prolonged hospitalization showing moderate-low specificity; phase angle showed a good predictive power in terms of AUC. NRS-2002 was significantly associated with LOS (β 12.62, SE 5.79). In a multivariate analysis, blood glucose level and the early warning score are independent predictors of death and need of ICU (OR 2.79, p ≤ 0.001; 1.59, p-0.029, respectively).Conclusion: Present findings confirm the clinical utility of NRS-2002 to assess nutritional risk in patients with COVID-19 at hospital admission and in predicting LOS, and that bioimpedance does not seem to add further predictive value. An early detection of nutritional risk has to be systematically included in the management of COVID-19 patients hospitalized in internal medicine wards.Keywords: COVID-19, malnutrition, bioelectrical impedance, nutritional risk score, risk of death, risk of ICU admission, length of hospital stay

Keywords

• covid-19 malnutrition bioelectrical impedance nutritional risk score risk of death risk of icu admission length of hospital stay