The Impact of Malnutrition in Patients Diagnosed with COVID-19
Malnutrition significantly increased the risk of mortality and adverse hospital events in patients hospitalized with COVID-19. In the United States, current estimates suggest that 20-50% of hospitalized patients have malnutrition. Malnutrition is a condition that develops when the body lacks sufficient vitamins, minerals and other nutrients needed to maintain healthy tissues and organ function. In hospitalized patients, malnutrition has been associated with poor outcomes, including increased risk of infection, increased length of stay, and higher in-hospital mortality rates. It is also significantly associated with lung function and is an independent risk factor for acute respiratory distress syndrome (ARDS). Considering these associations, our research team hypothesized that patients with malnutrition prior to COVID-19 infection may be more susceptible to poor outcomes during SARS-CoV-2 infection. Conversely, those without underlying malnutrition may become acutely malnourished during admission due to symptoms of COVID-19 such as anorexia, nausea, vomiting, and hypermetabolism.
At the University of Nebraska Medical Center, Dr. Jana Ponce and A. Jerrod Anzalone led a multidisciplinary team of researchers to investigate the impact of malnutrition on clinical outcomes in patients hospitalized with COVID-19. Although Academy of Nutrition and Dietetics (AND) and American Society of Parenteral and Enteral Nutrition (ASPEN) guidelines are preferred for the identification and diagnosis of malnutrition, variability in training and clinical assessment leads to a large number of billing codes used to indicate the condition. Therefore, the team utilized the international classification of diseases (ICD)-10 diagnostic codes to develop a unique clinical concept set within the National Center for Data to Health’s (CD2H) National COVID Cohort Collaborative (N3C) data enclave. The final concept set included 16 unique ICD-10 diagnostic codes that were representative of malnutrition and served as our primary exposure. Primary and secondary outcomes of interest included mortality and adverse hospital events (mechanical ventilation, acute respiratory distress syndrome, extra-corporeal membrane oxygenation and hospital-acquired pressure injury) respectively.
In fully adjusted logistic regression modeling, our team found malnutrition significantly increased the risk of mortality and adverse hospital events in patients hospitalized with COVID-19. Briefly, major findings show that patients with malnutrition who were hospitalized with COVID-19 were 2.5 times more likely to die, 5.7 times more likely to require mechanical ventilation, 13 times more likely to require extra-corporeal membrane oxygenation (ECMO) support and 6.9 times more likely to develop a hospital-acquired pressure injury. Findings were presented at the ASPEN 2022 Nutrition Science & Practice Conference in Seattle, Washington. The original manuscript was published in the Journal of Parenteral and Enteral Nutrition (JPEN) and featured on the ASPEN podcast.
The team led by Ponce and Anzalone plan to continue investigating nutritional implications in COVID-19, including the association between micronutrient deficiencies and post-acute sequelae of COVID-19 infection.
Recent Publications Include:
Bailey KL, Sayles H, Campbell J, Khalid N, Anglim M, Ponce J, Wyatt TA, McClay JC, Burnham EL, Anzalone A, Hanson C. COVID-19 patients with documented alcohol use disorder or alcohol-related complications are more likely to be hospitalized and have higher all-cause mortality. Alcohol Clin Exp Res.2022 Apr 15:10.1111/acer.14838. doi: 10.1111/acer.14838. PMID: 35429004; PMCID: PMC9111368.
Ponce J, Anzalone A, Bailey C, Sayles H, Timmerman M, Jackson M, McClay J, Hanson C. Impact of malnutrition on clinical outcomes in patients diagnosed with COVID-19. J Parenter Enteral Nutr. 2022; 1- 11. doi:10.1002/jpen.2418.
Acknowledgements: This project is supported by The National Center for Data to Health NCATS U24 TR002306, and the National Institute of General Medical Sciences, 5U54GM104942-04