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营养风险的 2019 年冠状病毒病(COVID-19)患者在一家三级政府医院的结局:MalnutriCoV 研究的随访研究。

Outcomes of nutritionally at-risk Coronavirus Disease 2019 (COVID 19) patients admitted in a tertiary government hospital: A follow-up study of the MalnutriCoV study.

机构信息

Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Philippines.

Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Philippines.

出版信息

Clin Nutr ESPEN. 2021 Jun;43:239-244. doi: 10.1016/j.clnesp.2021.04.008. Epub 2021 Apr 27.

Abstract

BACKGROUND AND AIMS

The prevalence of malnutrition among adult Filipino patients with COVID 19 is 71.83%. Malnutrition has long been associated with poor outcomes among patients with pneumonia. This may be due to the increased risk of malnourished patients to develop impaired muscle and respiratory function. We aimed to determine the outcomes of adult COVID 19 patients admitted in a tertiary government hospital accordingly to nutrition status and risk.

METHODS

Retrospective study on the adult COVID 19 patients admitted from July 15 to September 15, 2020 who were screened using the Philippine Society for Parenteral and Enteral Nutrition modified Subjective Global Assessment Grade tool. Chi-square or Fisher exact test, as well as Mann-Whitney U test or Kruskal-Wallis with post-hoc Dunn test, as appropriate were done. Survival analysis for mortality was done with right-censored data length of initial admission in days. Cox proportional hazard regression was done to determine the association of the main variables of interest with mortality with a 95% confidence interval.

RESULTS

Malnourished patients were 30% less likely to be discharged [HR 0.70 95% CI (0.50, 0.97)]; malnutrition was also associated with length of hospital stay as those who were malnourished had longer lengths of hospital stay of about 4 days on the average [HR 3.55 95% CI (0.83, 6.27)]. High nutrition risk was significantly associated with length of hospital stay [HR 4.36 95% CI (0.89, 7.83)].

CONCLUSION

The only risk factor for mortality shown in this study is ICU transfer. Malnutrition, moderate nutrition risk, and high nutrition risk were risk factors of having longer lengths of hospital stays. While only malnutrition was the risk factor for being less likely to be discharged. We reiterate that nutrition assessment and support are important in mitigating the effects of COVID 19.

摘要

背景和目的

在患有 COVID-19 的成年菲律宾患者中,营养不良的患病率为 71.83%。营养不良长期以来一直与肺炎患者的不良预后相关。这可能是由于营养不良患者发展为肌肉和呼吸功能受损的风险增加所致。我们旨在根据营养状况和风险确定入住三级政府医院的成年 COVID-19 患者的结局。

方法

这是一项回顾性研究,纳入了 2020 年 7 月 15 日至 9 月 15 日入住的成年 COVID-19 患者,使用菲律宾肠外和肠内营养学会改良的主观整体评估分级工具进行筛查。使用卡方或 Fisher 精确检验,以及适当的 Mann-Whitney U 检验或 Kruskal-Wallis 检验加事后 Dunn 检验进行分析。采用右删失数据入院初始天数进行死亡率的生存分析。Cox 比例风险回归分析确定主要感兴趣变量与死亡率的相关性,置信区间为 95%。

结果

营养不良患者出院的可能性降低 30%[HR 0.70 95% CI(0.50,0.97)];营养不良还与住院时间有关,因为营养不良患者的住院时间平均延长了约 4 天[HR 3.55 95% CI(0.83,6.27)]。高营养风险与住院时间显著相关[HR 4.36 95% CI(0.89,7.83)]。

结论

本研究显示唯一的死亡风险因素是 ICU 转科。营养不良、中度营养风险和高营养风险是住院时间延长的危险因素。而只有营养不良是出院可能性降低的危险因素。我们再次强调,营养评估和支持对于减轻 COVID-19 的影响非常重要。

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