Nutritional risk, not obesity, is associated with mortality in critically ill COVID-19 patients. 2022

Ana Carolina Palermo Dos Santos, and Camila Cremonezi Japur, and Clara Romanholi Passos, and Thereza Cristina Pereira Lunardi, and Wilson José Lovato, and Geórgia das Graças Pena
Multiprofessional Residency Program in Urgency and Emergency of the Hospital das Clínicas of Ribeirão Preto Medical School, University of São Paulo, 1000 Bernardino de Campos Street, Ribeirão Preto, SP 14015130, Brazil. Electronic address: acarolinapalermo@gmail.com.

Despite the identification of obesity as a risk factor for higher rates of hospital and Intensive Care Unit (ICU) admissions and complications due to COVID-19, the association between obesity and mortality in critically ill COVID-19 patients remains controversial, and the nutritional risk is little considered. Hence, our study sought to evaluate the association between obesity, nutritional risk, and mortality in critically ill patients diagnosed with COVID-19. Retrospective study were condutcted including adult critically ill COVID-19 patients admitted to an ICU between April 2020 and March 2021. Clinical and laboratory data were collected from electronic medical records. Obesity was classified by body mass index ≥ 30 kg/m2. A mNUTRIC score of ≥ 5 indicated high nutritional risk. Multiple Cox Regression was used to estimate the association between mNUTRIC, obesity, and mortality. From 71 patients aged 59 (± 15) years, 71.8 % were male. The frequencies of obesity (58.7 %) and death (49.3 %) were high, but obesity was not associated with mortality. Based on mNUTRIC, 85.9 % of patients were at high nutritional risk, presenting a higher frequency of mortality than patients at low nutritional risk (50.8 % vs 40.0 %; p = 0.014). Multiple Cox Regression showed that for each unit increase in mNUTRIC score the probability of death almost doubled, regardless of the presence of obesity (HR = 1.74; p < 0.001). A higher nutritional risk was positively associated with mortality in critically ill COVID-19 patients, regardless of obesity, showing the importance of early identification of nutritional risk for appropriate nutritional interventions in this population.

UI MeSH Term Description Entries
D008297 Male Males
D009752 Nutritional Status State of the body in relation to the consumption and utilization of nutrients. Nutrition Status,Status, Nutrition,Status, Nutritional
D009765 Obesity A status with BODY WEIGHT that is grossly above the recommended standards, usually due to accumulation of excess FATS in the body. The standards may vary with age, sex, genetic or cultural background. In the BODY MASS INDEX, a BMI greater than 30.0 kg/m2 is considered obese, and a BMI greater than 40.0 kg/m2 is considered morbidly obese (MORBID OBESITY).
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000086382 COVID-19 A viral disorder generally characterized by high FEVER; COUGH; DYSPNEA; CHILLS; PERSISTENT TREMOR; MUSCLE PAIN; HEADACHE; SORE THROAT; a new loss of taste and/or smell (see AGEUSIA and ANOSMIA) and other symptoms of a VIRAL PNEUMONIA. In severe cases, a myriad of coagulopathy associated symptoms often correlating with COVID-19 severity is seen (e.g., BLOOD COAGULATION; THROMBOSIS; ACUTE RESPIRATORY DISTRESS SYNDROME; SEIZURES; HEART ATTACK; STROKE; multiple CEREBRAL INFARCTIONS; KIDNEY FAILURE; catastrophic ANTIPHOSPHOLIPID ANTIBODY SYNDROME and/or DISSEMINATED INTRAVASCULAR COAGULATION). In younger patients, rare inflammatory syndromes are sometimes associated with COVID-19 (e.g., atypical KAWASAKI SYNDROME; TOXIC SHOCK SYNDROME; pediatric multisystem inflammatory disease; and CYTOKINE STORM SYNDROME). A coronavirus, SARS-CoV-2, in the genus BETACORONAVIRUS is the causative agent. 2019 Novel Coronavirus Disease,2019 Novel Coronavirus Infection,2019-nCoV Disease,2019-nCoV Infection,COVID-19 Pandemic,COVID-19 Pandemics,COVID-19 Virus Disease,COVID-19 Virus Infection,Coronavirus Disease 2019,Coronavirus Disease-19,SARS Coronavirus 2 Infection,SARS-CoV-2 Infection,Severe Acute Respiratory Syndrome Coronavirus 2 Infection,COVID19,2019 nCoV Disease,2019 nCoV Infection,2019-nCoV Diseases,2019-nCoV Infections,COVID 19,COVID 19 Pandemic,COVID 19 Virus Disease,COVID 19 Virus Infection,COVID-19 Virus Diseases,COVID-19 Virus Infections,Coronavirus Disease 19,Disease 2019, Coronavirus,Disease, 2019-nCoV,Disease, COVID-19 Virus,Infection, 2019-nCoV,Infection, COVID-19 Virus,Infection, SARS-CoV-2,Pandemic, COVID-19,SARS CoV 2 Infection,SARS-CoV-2 Infections,Virus Disease, COVID-19,Virus Infection, COVID-19
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D015596 Nutrition Assessment Evaluation and measurement of nutritional variables in order to assess the level of nutrition or the NUTRITIONAL STATUS of the individual. NUTRITION SURVEYS may be used in making the assessment. Prognostic Nutritional Index (PNI),Assessment, Nutrition,Mini Nutrition Assessment,Mini Nutritional Assessment,Nutrition Assessments,Nutrition Index,Nutrition Indexes,Nutrition Indices,Nutritional Assessment,Nutritional Index,Prognostic Nutritional Index,Assessment, Mini Nutrition,Assessment, Mini Nutritional,Assessment, Nutritional,Assessments, Mini Nutrition,Assessments, Mini Nutritional,Assessments, Nutrition,Assessments, Nutritional,Index, Nutrition,Index, Nutritional,Index, Prognostic Nutritional,Index, Prognostic Nutritional (PNI),Indexes, Nutrition,Indices, Nutrition,Indices, Nutritional,Indices, Prognostic Nutritional,Indices, Prognostic Nutritional (PNI),Mini Nutrition Assessments,Mini Nutritional Assessments,Nutrition Assessment, Mini,Nutrition Assessments, Mini,Nutritional Assessment, Mini,Nutritional Assessments,Nutritional Assessments, Mini,Nutritional Index, Prognostic,Nutritional Index, Prognostic (PNI),Nutritional Indices,Nutritional Indices, Prognostic,Nutritional Indices, Prognostic (PNI),Prognostic Nutritional Indices,Prognostic Nutritional Indices (PNI)
D016638 Critical Illness A disease or state in which death is possible or imminent. Critically Ill,Critical Illnesses,Illness, Critical,Illnesses, Critical

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