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Publications

Journal Article Multicenter Study Epublish

PubMed: 42942949 DOI: 10.3390/nu18203378

Nutritional Status at Admission and Clinical Outcomes in Hospitalized Patients with COVID-19: Results from the MODIeCOSe in Italy Study.

Nutrients 18(20)

Authors: Carola Buscemi, Matteo Monami, Cristiana Randazzo, Anna Maria Barile, Benedetta Ragghianti, Chiara Davoli, Enrico Maria Trecarichi, Helen Linda Morrone, Bruno Tassone, Piero Colombrita, Carlo Cottone, Maria Elena Greggi, Paolo Sbraccia, Valeria Guglielmi, Frida Leonetti, Danila Capoccia, Alexis Elias Malavazos, Sara Basilico, Ferruccio Santini, Alessandro Antonelli, Nicola Viola, Carlo Torti, Silvio Buscemi

Affiliations

  • Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy.
  • Unit of Internal Medicine, V. Cervello Hospital, 90133 Palermo, Italy.
  • Diabetology and Metabolic Disease Unit, Careggi Teaching Hospital and University of Florence, 50134 Florence, Italy.
  • Unit of Clinical Nutrition, Obesity and Metabolic Diseases, University Hospital Policlinico "P. Giaccone", Piazza delle Cliniche 2, 90127 Palermo, Italy.
  • Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University-"Mater Domini" Teaching Hospital, 88100 Catanzaro, Italy.
  • Department of Life Science, Health, and Health Professions, Link Campus University, 00165 Rome, Italy.
  • COVID Internal Medicine Unit, Petralia Sottana Hospital, ASP 6, 90127 Palermo, Italy.
  • Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy.
  • Internal Medicine Unit-Obesity Center, University Hospital Policlinico Tor Vergata, 00133 Rome, Italy.
  • Diabetes Unit, Department of Medical-Surgical Sciences and Biotechnology, Santa Maria Goretti Hospital, "La Sapienza" University of Rome, 04100 Latina, Italy.
  • Endocrinology Unit, Clinical Nutrition and Cardiometabolic Prevention Service, IRCCS Policlinico San Donato, 20122 Milan, Italy.
  • Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy.
  • Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
  • Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy.
  • Department of Healthcare Surveillance and Bioethics, Section of Infectious Diseases, Catholic University of Sacred Heart, 00168 Rome, Italy.
  • Infectious Diseases Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, 00133 Rome, Italy.

Abstract

Background/Objectives: Poor nutritional status is common among hospitalized patients and may adversely affect the response to severe acute illness. We investigated the association between nutritional status at hospital admission and clinical outcomes in patients hospitalized with COVID-19 during the first two pandemic waves in Italy. Methods: This retrospective multicenter study included 1187 patients hospitalized with COVID-19 across nine Italian centers participating in the MODIeCOSe in Italia registry. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score, the Prognostic Nutritional Index (PNI), and available anthropometric measures. The primary outcome was a composite of in-hospital death or transfer to an intensive care unit (ICU). Multivariable logistic regression was used to assess the independent association between nutritional status and outcome. Results: Overall, 275 patients (23.2%) experienced the composite adverse outcome. CONUT score was higher in patients with an adverse than in those with a favorable outcome (4.4 ± 2.3 vs. 3.4 ± 1.8; p < 0.001), whereas PNI did not differ significantly. Patients with an adverse outcome also had lower body weight, BMI, waist circumference, and waist-to-height ratio, although anthropometric data were available only in subsets of the cohort. In the main multivariable model adjusted for admission PaO 2/FiO 2 and relevant clinical covariates, higher CONUT remained independently associated with adverse outcome (OR 1.65, 95% CI 1.12-2.45 per 1-SD increase; p = 0.01). The association was similar in a sensitivity analysis excluding PaO 2/FiO 2 (OR 1.79, 95% CI 1.28-2.49; p < 0.001). Conclusions: A higher CONUT score at admission was independently associated with an increased risk of in-hospital death or ICU transfer, supporting its prognostic relevance as an immuno-nutritional index in hospitalized patients with COVID-19.

MeSH

Malnutrition, Food, Covid-19, Anthropometry, Nutritional Status, Intensive Care Units, Prognosis, Acute Disease