Nutritional risk and therapy for severe and critical COVID-19 patients: a multicenter retrospective observational study

Li, Gang; Zhou, Chen-liang; Ba, Yuan-ming; Wang, Ye-ming; Song, Bin; Cheng, Xiao-bin; Dong, Qiu-fen; Wang, Liu-lin; You, Sha-sha

Objective To evaluate the nutritional risk and therapy in severe and critical patients with COVID-19. Methods A total of 523 patients enrolled from four hospitals in Wuhan, China. The inclusion time was from January 2, 2020 to February 15. Clinical characteristics and laboratory values were obtained from electronic medical records, nursing records, and related examinations. Results Of these patients, 211 (40.3%) were admitted to the ICU and 115 deaths (22.0%). Patients admitted to the ICU had lower BMI and plasma protein levels. The median Nutrition risk in critically ill (NUTRIC) score of 211patients in the ICU was 5(4, 6) and Nutritional Risk Screening (NRS) score was 5(3, 6). The ratio of parenteral nutrition (PN) therapy in non-survivors was greater than that in survivors, and the time to start nutrition therapy was later than that in survivors. The NUTRIC score can independently predict the risk of death in the hospital (OR=1.197, 95%CI: 1.091-1.445, p=0.006) and high NRS score patients have a higher risk of poor outcome in the ICU (OR=1.880, 95%CI: 1.151-3.070, p=0.012). After adjusted age and sex, for each standard deviation increase in BMI, the risk of in-hospital death was reduced by 13% (HR=0.871, 95%CI: 0.795-0.955, p=0.003), and the risk of ICU transfer was reduced by 7% (HR=0.932, 95%CI:0.885-0.981, p=0.007). The in-hospital survival time of patients with albumin level ≤ 35 g/L was significantly decreased (15.9d, 95% CI: 13.7-16.3, vs 24.2d, 95% CI: 22.3-29.7, p<0.001). Conclusion Severe and critical patients with COVID-19 have a high risk of malnutrition. Low BMI and protein levels were significantly associated with adverse events. Early nutritional risk screening and therapy for patients with COVID-19 are necessary.