Prognostic role of nutritional status in elderly patients hospitalized for COVID-19: a monocentric study
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ORIGINAL ARTICLE
Prognostic role of nutritional status in elderly patients hospitalized for COVID‑19: a monocentric study Guerino Recinella1 · Giovanni Marasco2 · Giovanni Serafini1 · Lorenzo Maestri1 · Giampaolo Bianchi1,2 · Paola Forti1,2 · Marco Zoli1,2 Received: 26 July 2020 / Accepted: 26 September 2020 © The Author(s) 2020
Abstract Background Symptomatic severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection incidence is higher in the elderly patients. Pre-existing geriatric conditions such as comorbidity and frailty seem related to worse hospital outcomes. Aims To assess the role of nutritional status as an independent prognostic factor for in-hospital death in elderly patients. Methods Consecutive elderly patients (age > 65 years) hospitalized for novel coronavirus disease (COVID-19) were enrolled. Demographics, laboratory and comorbidity data were collected. Nutritional status was evaluated using the Geriatric Nutritional Risk Index (GNRI). Uni- and multivariate Cox regression analyses to evaluate predictors for in-hospital death were performed. Results One hundred and nine hospitalized elderly patients (54 male) were consecutively enrolled. At univariate analysis, age (HR 1.045 [CI 1.008–1.082]), cognitive impairment (HR 1.949 [CI 1.045–3.364]), C-reactive protein (HR 1.004 [CI 1.011–1.078]), lactate dehydrogenases (HR 1.003 [CI 1.001–1.004]) and GNRI moderate–severe risk category (HR 8.571 [CI 1.096–67.031]) were risk factors for in-hospital death, while albumin (HR 0.809 [CI 0.822–0.964]), P aO2/FiO2 ratio (HR 0.996 [CI 0.993–0.999]) and body mass index (HR 0.875 [CI 0.782–0.979]) were protective factors. Kaplan–Meier survival curves showed a significative higher survival in patients without GNRI moderate or severe risk category (p = 0.0013). At multivariate analysis, P aO2/FiO2 ratio (HR 0.993 [CI 0.987–0.999], p = 0.046) and GNRI moderate–severe risk category (HR 9.285 [1.183–72.879], p = 0.034) were independently associated with in-hospital death. Conclusion Nutritional status assessed by GNRI is a significative predictor of survival in elderly patients hospitalized for COVID-19. The association between GNRI and PaO2/FiO2 ratio is a good prognostic model these patients. Keywords COVID-19 · Elderly · Nutrition · Geriatric nutritional risk index
Introduction
* Guerino Recinella [email protected] * Giovanni Marasco [email protected] 1
Unit of Internal Medicine, Department of Medical and Surgical Sciences, S. Orsola‑ Malpighi University Hospital, University of Bologna, Via Pietro Albertoni 15, 40138 Bologna, Italy
Department of Medical and Surgical Sciences, S. Orsola‑Malpighi Hospital, University of Bologna, Via Pietro Albertoni 15, 40138 Bologna, Italy
2
Since the beginning of the novel coronavirus disease (COVID-19) emergency in Italy, more than 200,000 infections and more than 30,000 deaths have been documented. Although most patients suffer from a mild illness, a relatively high percentage of patients need to be hospitalized so the pande
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