A retrospective cohort study of nutritional risk, nutritional supplementation and outcomes in covid-19

Abstract

Rationale: This study aimed to characterise nutritional risk in COVID-19 inpatients, their outcomes based on nutritional risk status (inflammatory response, length of stay, ICU admission, inpatient mortality), and whether or not nutritional supplementation had any association with inpatient mortality. Methods: This was a retrospective cohort study of adult inpatients admitted to University College London Hospital between February 2020 and July 2020 with PCR-confirmed SARS-CoV-2 (n=518). Data were collected in a de-identified fashion from a paperless digital platform. 73.6% of patients (n=381) had nutritional assessment on admission and were classified as low, moderate or high nutritional risk using the local Nutritional Scoring Tool (NST). Unpaired Student’s T-tests were performed to compare statistical differences between mean values. Multivariate logistic regressions were performed to generate adjusted odds ratios accounting for co-morbidities (chronic lung disease, hypertension, diabetes, AKI/CKD, cancer, dementia), age>70, ICU admission and gender. Statistical significance was determined as p <.05. Results: 34.6% of patients (n=132) were assessed as high nutritional risk, 23.4% (n=89) were assessed as moderate nutritional risk and 42.0% (n=160) were asessed as low nutritional risk on admission to hospital. Mean peak CRP of patients at moderate and high nutritional risk was 30 mg/L higher than those at low nutritional risk (p <.05, 95% CI 3 mg/L to 57 mg/L), and mean nadir albumin was 3g/L lower (p <.0001, 95% CI 2 g/L to 5 g/L). Inpatient length of stay was 5.8 days longer in patients at moderate and high nutritional risk compared to those at low nutritional risk (p <.001, 95% CI 2.4 to 9.2 days). Moderate nutritional risk on admission was an independent risk factor for ICU admission, adjusted OR 2.18 (95% CI 1.18 to 4.00), p <.05. High nutritional risk was an independent risk factor for mortality, adjusted OR 3.13 (95% CI 1.79 to 5.53), p <.0001. In patients at high nutritional risk, nutritional supplementation with oral nutritional supplements and/or nasogastric feeding was associated with lower odds of inpatient mortality, adjusted OR 0.26 (95% CI 0.09 – 0.69), p <.001. Overall, 64.8% of patients at high nutritional risk received nutritional supplementation. Conclusion: A large proportion of COVID-19 patients are at moderate or high nutritional risk on admission to hospital. This study showed they had a greater inflammatory response and longer length of stay compared to those at low nutritional risk. Patients at moderate nutritional risk had greater odds of requiring ICU admission, and patients at high nutritional risk had greater odds of inpatient mortality. Nutritional supplementation in the high nutritional risk group was associated with lower odds of inpatient mortality, yet only two-thirds received this simple intervention. More attention should be paid to nutritional assessment and supplementation in this high-prevalence, high-risk group of patients. Disclosure of Interest: None declared.