Dear Editor,
We read with great interest the article by Lidoriki et al. [1] about nutritional and functional status as a prognostic factors in elderly patients with novel coronavirus disease 2019 (COVID-19).
The authors, mentioning previous studies [2], [3], propose a prognostic association between nutritional and functional status of patients and prognosis after COVID-19 infection.
We want to share our preliminary data which seem to confirm this hypothesis which we believe strongly.
A prospective study assessing prognostic factors in the elderly with COVID-19 is ongoing in our Center. To date, we consecutively enrolled 37 patients aged ≥ 65 years admitted to the Geriatric ward with COVID-19 diagnosis. The median age was 82 years (IQR 74.5–93.5). Demographics, laboratory exams, past medical history and the clinical findings were collected. We compared these characteristics between the group of patients experiencing or not in-hospital death (Table 1 ).
Table 1.
Differences in demographics, laboratory exams at admission, past medical history and clinical findings undergoing or not to in-hospital death.
| Survivors (n = 26), n (%) or median (IQR) | In-hospital death (n = 11), n (%) or median (IQR) | p | |
|---|---|---|---|
| Male | 15 (57.7) | 4 (36.4) | 0.235 |
| Age | 80.5 (73.7–92.2) | 90 (82–95) | 0.083 |
| Length of hospitalization, days | 7 (5–10.2) | 8 (5–13) | 0.854 |
| BMI, kg/m2 | 24.9 (22.7–28.3) | 22.9 (21.7–23.7) | 0.036 |
| Charlson comorbidity index | 4 (0.7–7) | 5 (4–7) | 0.305 |
| ADL | 3 (0–6) | 1 (0–6) | 0.624 |
| IADL | 1.5 (0–8) | 0 (0–8) | 0.379 |
| Hypertension | 17 (65.4) | 6 (54.5) | 0.534 |
| Chronic kydney disease | 3 (11.5) | 3 (18.2) | 0.589 |
| Previous stroke | 3 (11.5) | 1 (9.1) | 0.827 |
| Neoplasia | 4 (15.4) | 0 (0) | 0.168 |
| Cognitive impairment | 12 (46.2) | 4 (36.4) | 0.583 |
| Laboratory parameters at admission | |||
| PaO2/FiO2 at entrance | 336 (265–378) | 329 (282–380) | 0.757 |
| White Blood Cells, x109/L | 6.76 (5.04–10.09) | 8.79 (5.87–12.45) | 0.238 |
| Lymphocytes, x109/L | 1.30 (0.90–1-51) | 1.38 (0.28–1.67) | 0.868 |
| C-reactive protein, mg/dL | 8.16 (2.93–13.46) | 4.18 (2.58–15.54) | 0.455 |
| Ferritin, ng/mL | 191 (88.5–438) | 195 (27–1032) | 0.786 |
| LDH, U/L | 217 (135–440) | 217 (162–254) | 0.796 |
| Albumin, g/L | 31.3 (26–34.7) | 24.4 (13.7–30.6) | 0.126 |
n = numbers. IQR = Interquartile-range. BMI = Body Mass Index. LDH = lactate dehydrogenases. GRF glomerular filtration rate. Categorical variables were compared with Chi-square test; Continuous variables were compared with Mann-Whitney test.
In our population, 11 (29.7%) patients underwent in-hospital death. We found a significantly lower Body Mass Index (BMI) in the in-hospital death group (p = 0.036), probably due to a worsened “nutritional status” of that group.
A prognostic role of nutritional parameters in COVID-19 elderly patients may also be suggested by lower median value of albumin in the “in-hospital death” group, although this difference was not statistically significant in our interim analysis, maybe due to the sample size.
Thus, according to our preliminary results, we support the hypothesis of Lidoriki et al. [1] about the prognostic role of nutritional status in elderly patients with the diagnosis of COVID-19.
In our opinion, a wide assessment of the nutritional status should be taken into account for setting correct management of elderly COVID-19 patients.
Future larger studies, on hospitalized elderly patients with COVID-19 should assess the nutritional status of patients in order to understand the real impact of this risk factor on disease-related mortality in the short term.
Statement of human and animal rights and informed consent
The study was conducted according to the declaration of Helsinki's ethical principles for medical research involving human subjects. The protocol was reviewed and approved by the Ethics Committee of the S. Orsola-Malpighi Hospital. Patient informed consent was obtained for each patient.
Source of funding
The authors received no specific funding for this work.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
References
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