Division of Endocrinology, Diabetology and Metabolism, University Hospital of Lausanne and University of Lausanne, Avenue de la Sallaz 8, 1011 Lausanne, Switzerland; School of Life Sciences, Ecole Polytechnique fédérale de Lausanne, SV, Station 19, 1015 Lausanne, Switzerland.
Division of Endocrinology, Diabetology and Metabolism, University Hospital of Lausanne and University of Lausanne, Avenue de la Sallaz 8, 1011 Lausanne, Switzerland.
Clin Nutr ESPEN. 2023 Jun;55:357-363. doi: 10.1016/j.clnesp.2023.04.001. Epub 2023 Apr 11.
This study aimed at evaluating associations between nutritional status and outcomes in patients with Covid-19 and to identify statistical models including nutritional parameters associated with in-hospital mortality and length of stay.
Data of 5707 adult patients hospitalized in the University Hospital of Lausanne between March 2020 and March 2021 were screened retrospectively 920 patients (35% female) with confirmed Covid-19 and complete data including nutritional risk score (NRS 2002), were included. This cohort was divided into three subgroups: NRS <3: no risk of malnutrition; NRS ≥3 to <5: moderate risk malnutrition; and NRS ≥5: severe risk of malnutrition. The primary outcome was the percentage of in-hospital deaths in the different NRS subgroups. The secondary outcomes were the length of hospital stay (LOS), the percentage of admissions to intensive care units (ICU), and the length of stay in the ICU (ILOS). Logistic regression was performed to identify risk factors associated with in-hospital mortality and hospital stay. Multivariate clinical-biological models were developed to study predictions of mortality and very long length of stay.
The mean age of the cohort was 69.7 years. The death rate was 4 times higher in the subgroup with a NRS ≥ 5 (44%), and 3 times higher with a NRS ≥ 3 to <5 (33%) compared to the patients with a NRS<3 (10%) (p < 0.001). LOS was significantly higher in the NRS ≥ 5 and NRS ≥ 3 to <5 subgroups (26.0 days; CI [21; 30.9]; and 24.9; CI [22.5; 27.1] respectively) versus 13.4; CI [12; 14.8] for NRS<3 (p < 0.001). The mean ILOS was significantly higher in the NRS ≥ 5 (5.9 days; versus 2.8 for NRS ≥ 3 to <5, and 1.58 for NRS<3 (p < 0.001)). In logistic regression, NRS ≥ 3 was significantly associated with the risk of mortality (OR: 4.8; CI [3.3; 7.1]; p < 0.001) and very long in-hospital stay (>12 days) (OR: 2.5; CI [1.9; 3.3]; p < 0.001). Statistical models that included a NRS ≥ 3 and albumin revealed to be strong predictors for mortality and LOS (area under the curve 0.800 and 0.715).
NRS was found to be an independent risk factor for in-hospital death and LOS in hospitalized Covid-19 patients. Patients with a NRS ≥ 5 had a significant increase in ILOS and mortality. Statistical models including NRS are strong predictors for an increased risk of death and LOS.
本研究旨在评估新冠患者的营养状况与结局之间的关联，并确定与住院死亡率和住院时间相关的包含营养参数的统计学模型。
回顾性筛选了 2020 年 3 月至 2021 年 3 月期间在洛桑大学医院住院的 5707 名成年患者的数据，共纳入 920 名（35%为女性）确诊为新冠且具有完整数据（包括营养风险评分[NRS 2002]）的患者。该队列分为三个亚组：NRS<3：无营养不良风险；NRS≥3 至<5：中度营养不良风险；NRS≥5：严重营养不良风险。主要结局为不同 NRS 亚组的住院内死亡率。次要结局为住院时间（LOS）、入住重症监护病房（ICU）的比例和 ICU 住院时间（ILOS）。采用逻辑回归确定与住院死亡率和住院时间相关的危险因素。建立多变量临床-生物学模型以研究死亡率和极长住院时间的预测因素。
该队列的平均年龄为 69.7 岁。NRS≥5 亚组的死亡率是 NRS<3 亚组的 4 倍（44%），NRS≥3 至<5 亚组的死亡率是 NRS<3 亚组的 3 倍（33%）（p<0.001）。NRS≥5 和 NRS≥3 至<5 亚组的 LOS 显著更高（26.0 天；CI[21；30.9]；和 24.9；CI[22.5；27.1]），而 NRS<3 亚组为 13.4；CI[12；14.8]（p<0.001）。NRS≥5 亚组的平均 ILOS 显著更高（5.9 天；NRS≥3 至<5 亚组为 2.8 天，NRS<3 亚组为 1.58 天（p<0.001））。逻辑回归显示，NRS≥3 与死亡率（OR：4.8；CI[3.3；7.1]；p<0.001）和极长住院时间（>12 天）（OR：2.5；CI[1.9；3.3]；p<0.001）的风险显著相关。包含 NRS≥3 和白蛋白的统计模型被证明是死亡率和 LOS 的强预测因子（曲线下面积为 0.800 和 0.715）。
NRS 被发现是新冠住院患者住院内死亡和 LOS 的独立危险因素。NRS≥5 的患者 ILOS 和死亡率显著增加。包含 NRS 的统计模型是死亡率和 LOS 风险增加的强预测因子。
