Table 1.
Nutritional assessment measures in COVID-19 and their correlation with disease severity and prognosis.
| Sample Size | Age (Years) | Male Gender | Nutritional Measure | COVID-19 Outcomes | Malnutrition Prevalence | Malnutrition Association with COVID-19 Outcomes | Ref. |
|---|---|---|---|---|---|---|---|
| 141 | 71.7 ± 5.9 | 48.2% | NRS-2002, MUST, MNA-sf, NRI | LOS, hospital expenses, appetite, disease severity, weight change | Malnutrition was identified by NRS-2002, MUST, MNA-sf, NRI in 85.8%, 41.1%, 77.3%, and 71.6% of patients, respectively. | Patients high on NRS 2002, MNA-sf, and NRI had significantly longer LOS, higher hospital expenses, poor appetite, disease severity, and more weight loss. | [34] |
| 136 | Median age = 69 (IQR: 57–77) | 63% | mNUTRIC | Mortality within 28 days of ICU admission | Malnutrition was identified in 61% of critically ill patients. | Compared with low NR patients, malnourished patients had higher mortality (87% vs. 49%, p < 0.001), the higher probability of death at ICU 28-day (adjusted HR = 2.01, 95% CI: 1.22–3.32, p = 0.006), higher incidence of ARDS, acute myocardial injury, secondary infection, shock, and use of vasopressors. | [43] |
| 114 | 59.9 ± 15.9 | 60.5% | GLIM | Clinical, radiological, and biological characteristics of COVID-19 patients | Moderate and severe malnutrition developed in 23.7%, and 18.4% in the whole sample, and in 66.7% of patients in the ICU. | GLIM correlated with lower albumin level and increased ICU admission regardless of age and CRP level. | [53] |
| 413 | 60.3 ± 12.7 | 51% | NRS-2002 | BMI, inflammatory and nutritional markers | Among all patients, severe, and critical patients, moderate malnutrition developed in 76%, 84%, and 38% of patients, respectively while severe malnutrition developed in 16%, 7%, and 62% of patients, respectively. | High NRS-2002 scores in critically ill patients correlated with inflammatory and nutrition-related markers, LOS, and a higher risk of mortality. | [28] |
| 182 | 68.5 ± 8.8 | 36% | MNA | Comorbidities, BMI, calf circumference, albumin, hemoglobin, and lymphocyte counts | Malnutrition and risk of malnutrition in developed in 52.7% and 27.5% of patients, respectively. | A score comprising a combination of diabetes mellitus, low calf circumference, and low albumin is an independent risk factor for malnutrition. | [48] |
| 348 | 66 (range = 56 to 73) | 52% | CONUT | Inflammation and malnutrition markers, mortality, muscle dystrophy | Mild and moderate-severe NR were identified in 46.3% and 39.9% of patients, respectively | Moderate-severe malnutrition correlated with age, inflammation and nutrition markers, the development of acute cardiac injury, and all-cause mortality. | [41] |
| 429 | 48.3% > 61 | 65.7% | CONUT | Clinical condition and COVID-19 adverse effects (ICU admission and all-cause death). | Malnutrition was identified in 65.7% of patients. | High CONUT score correlated with old age, diabetes, and hospital admission. Older adults with a high CONUT score had a 6.2 times higher risk of adverse outcomes. Gender, age, hypertension, and urinary erythrocytes were the key factors affecting adverse outcomes. High sensitivity and specificity of the CONUT on the ROC curve. | [47] |
| 295 | 58 (44–69) | 52.5% | GNRI, PNI, CONUT | Nutritional, inflammatory, and renal biomarkers, clinical data, and in-hospital death | Moderate and severe NR in critically ill patients were 10% and 30% on the PNI score and 34.6% and 30.8% on the CONUT score | Critically ill patients had significantly lower albumin levels and higher blood urea nitrogen and serum creatinine, CRP, IL6 than severe or mild/moderate patients (p < 0.0001). Baseline nutritional status correlated with in-hospital mortality. Good prognostic implication of GNRI and CONUT score on the ROC curve |
[55] |
| 245 | Median age = 55 | 46.5% | PNI and CONUT | In-hospital mortality, clinical data, laboratory, and nutritional biomarkers. | Moderate and severe NR were identified in 12.7% and 12.2% on the PNI score and in 23.7% and 2.8% of patients on the CONUT score. | CONUT score (OR = 3.371,95% CI 1.124–10.106, p = 0.030) and PNI (OR = 0.721, 95% CI 0.581–0.896, p = 0.003) were independent predictors of all-cause death at an early stage. Higher PNI was an independent risk predictor of in-hospital death (OR = 24.225, 95% CI 2.147–273.327, p = 0.010). | [54] |
| 442 | 58 (41–70) | 46.6% | CONUT and NRS-2002 | In-hospital mortality, markers of inflammation, nutrition, renal, and liver function, COVID-19 complications | CONUT identified severe malnutrition in 7.6% of non-survivors. | In adjusted analysis, CONUT (p = 0.002), LDH (p < 0.001), CRP (p = 0.020) were risk factors of mortality in COVID-19 patients. Better prognostic potential of CONUT and combined CONUT-LDH-CRP than NRS-2002. |
[45] |
| 108 | 62 ± 16 | 62.9% | NRI, BMI, 5% or 10% weight loss in the previous month or 6 months | Need for nasal oxygen, markers of inflammation, and nutrition. | NRI identified malnutrition and risk for malnutrition in 38.9% and 84.9% of patients. | NRI scores correlated with inflammation; lower plasma levels of proteins, albumin, prealbumin, and zinc, and the need for oxygen therapy. | [56] |
| 41 | 55 (19–85) | 51.2% | MNA | BMI, weight loss, anemia, and serum levels of Ca, Zn, Mg, albumin, and vitamin D. | MNA identified malnutrition and risk for malnutrition in 14.6% and 65.9% of ICU-discharged patients. | Weight loss in 61% (>10% of body weight in 26.2%) of patients. Hypoalbuminemia, hypoproteinemia, hypocalcemia, anemia, hypomagnesemia, and hypovitaminosis D were detected in 19.5%, 17.1%,19.5%, 34.1%, 12.2%, and 51.2% of patients, respectively. |
[52] |
| 185 | 57 (48–67) | 65.5% | MNA | Need for follow-up due to dyspnea, tachypnea, new-onset cognitive impairment, and post-traumatic stress. | MNA identified malnutrition and risk for malnutrition in 5.4% and 57.3% of patients, 100 days following discharge from the hospital or ICU. | BMI and ≥33 Kg/m2, arterial oxygen partial pressure to fractional inspired oxygen ratio < 324, age > 63 years, diabetes, and non-invasive ventilation highly predicted the need for follow-up. | [50] |
| 213 | Median age = 59 (49.5–67.9) | 66% | MNA | Appetite, weight loss, and inflammation biomarkers. | MNA identified malnutrition and risk for malnutrition in 6.6% and 54.7% of remitting patients, following discharge from the hospital or treatment at home. | High risk of malnutrition among hospital and ICU admitted patients. Weight loss > 10% of initial body weight in hospitalized and home-treated patients (9.6% vs. 5.3%, p = 0.41) was associated with high CRP, renal injury, longer LOS, and disease duration independent of age, sex, pre-existing comorbidities, and most of the biochemical parameters upon admission. | [51] |
Abbreviations: NRS-2002: Nutrition Risk Screening 2002, MUST: Malnutrition Universal Screening Tool, MNA-sf: Mini Nutrition Assessment Shortcut, NRI: Nutrition Risk Index, GLIM: Global Leadership Initiative on Malnutrition, GNRI: Geriatric Nutritional Risk Index, PNI: Prognostic Nutritional Index, CONUT: Controlling Nutritional Status, mNUTRIC: modified Nutrition Risk in the Critically ill, ROC: receiver operating characteristic curves, ICU: intensive care unit, LOS: length of stay, BMI: body mass index, ARDS: acute respiratory distress syndrome, LDH: lactate dehydrogenase, CRP: C-reactive protein, NR: nutritional risk.