Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Nursing Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
J Int Med Res. 2024 Nov;52(11):3000605241292326. doi: 10.1177/03000605241292326.
To evaluate the relationship between nutritional scoring systems, nutritional support methods, and the prognosis of severe and critically ill patients infected with the Omicron variant of coronavirus disease 2019 (COVID-19).
Patients with confirmed Omicron variant severe and critical COVID-19, who were admitted to Chongqing Medical University First Hospital between December 2022 and January 2023, were enrolled into this retrospective study. Clinical data of patients who survived for 28 days were compared with those who died during the same period. Nutritional status was assessed using the 2002 Nutrition Risk Screening (NRS) tool and Prognostic Nutritional Index (PNI). Factors influencing patient mortality were identified by multivariate logistic regression, and the relationship between patient nutrition and mortality as the disease progressed was illustrated using Kaplan-Meier curves. The study was registered on the ChiCTR platform (No. ChiCTR2300067595).
A total of 508 patients were included (349 survivors and 159 non-survivors). Significant differences were found in sex, age, NRS score, PNI score, albumin level, lymphocyte count, chronic comorbidities, mechanical ventilation, neutrophil count, procalcitonin, and platelet count between survivors and non-survivors. Multivariate analysis revealed that high NRS score (OR 3.87, 95% CI, 1.97, 7.63), fourth-level nutritional support (combined enteral and parenteral nutrition; OR 7.89, 95% CI, 1.32, 47.28), chronic comorbidities (OR 4.03, 95% CI, 1.91, 8.51), and mechanical ventilation (OR 6.03, 95% CI, 3, 12.13) were risk factors for mortality (OR > 1). The malnutrition rate among patients with NRS ≥ 3 was 41.93%. The median (interquartile range) PNI score was 38.20 (35.65, 41.25) for survivors versus 32.65 (29.65, 36.58) for non-survivors. The mortality rate was higher in patients with high nutritional risk within 28 days of hospitalization. The descending order for mortality rate in patients receiving different nutritional support was: dual parenteral and enteral nutrition, no nutritional intervention, single enteral nutrition, and single parenteral nutrition.
A high proportion of severe and critically ill patients with COVID-19 experience malnutrition, and various factors are associated with their prognosis. High nutritional risk is significantly related to patient mortality. Early assessment using NRS or PNI is crucial for these patients, and personalized interventions should be implemented to improve overall nutritional status, maintain organ function, and enhance the body's antiviral defence.
评估营养评分系统、营养支持方法与感染 2019 年冠状病毒病（COVID-19）奥密克戎变异株的重症和危重症患者预后之间的关系。
本回顾性研究纳入 2022 年 12 月至 2023 年 1 月期间重庆医科大学附属第一医院收治的确诊奥密克戎变异株的重症和危重症 COVID-19 患者。比较存活 28 天患者的临床资料与同期死亡患者。采用 2002 年营养风险筛查（NRS）工具和预后营养指数（PNI）评估患者的营养状况。采用多因素 logistic 回归确定影响患者死亡率的因素，并通过 Kaplan-Meier 曲线说明患者营养状况与疾病进展的关系。该研究在 ChiCTR 平台（注册号：ChiCTR2300067595）上注册。
共纳入 508 例患者（349 例存活患者和 159 例非存活患者）。存活患者和非存活患者在性别、年龄、NRS 评分、PNI 评分、白蛋白水平、淋巴细胞计数、慢性合并症、机械通气、中性粒细胞计数、降钙素原和血小板计数方面存在显著差异。多因素分析显示，NRS 评分高（OR 3.87，95%CI，1.97，7.63）、四级营养支持（联合肠内和肠外营养；OR 7.89，95%CI，1.32，47.28）、慢性合并症（OR 4.03，95%CI，1.91，8.51）和机械通气（OR 6.03，95%CI，3，12.13）是死亡的危险因素（OR>1）。NRS≥3 的患者营养不良发生率为 41.93%。存活患者的中位（四分位间距）PNI 评分为 38.20（35.65，41.25），而非存活患者的 PNI 评分为 32.65（29.65，36.58）。住院 28 天内高营养风险患者的死亡率更高。接受不同营养支持的患者死亡率依次为：双肠外和肠内营养、无营养干预、单肠内营养和单肠外营养。
COVID-19 重症和危重症患者营养不良发生率较高，多种因素与患者预后相关。高营养风险与患者死亡率显著相关。早期使用 NRS 或 PNI 评估至关重要，应实施个性化干预措施，改善整体营养状况，维持器官功能，增强机体抗病毒防御能力。
