Nutritional risk at hospital admission and its long-term impact on COVID-19 survivors in Ha`il region, Saudi Arabia
Keywords:
Malnutrition, COVID-19, Intensive care unit, Body mass index.Abstract
Background and aim: This study aims to investigate the relationship between nutritional risk at hospital admission and its effect on severe outcomes and length of hospital stay in hospitalized COVID-19 patients, both with and without comorbidities.
Methods: This prospective cohort study included 103 COVID-19 patients hospitalized at King Salman Specialist Hospital in the Ha'il region of Saudi Arabia. Of 600 eligible patients contacted, 103 consented to participate, representing one of the first comprehensive investigations of nutritional risk in COVID-19 survivors in this region. Retrospective data were obtained from patient records at admission, covering sociodemographic details, clinical characteristics, symptoms, anthropometric measurements, nutrition-related laboratory results, and length of hospital stay. The Malnutrition Screening Tool was used to evaluate malnutrition risk at admission and follow-up, while body mass index was calculated using height and weight measurements taken at these time points.
Results: Body mass index was not uniformly observed across all categories. Significant increase in Calcium (p-value 0.0001) was noted between admission and follow-up visits in COVID-19 patients. Ferritin levels were significantly decreased and associated with admission and follow-up only in patients without comorbidities (p-value 0.002). Although albumin levels differed significantly across all participants (p-value 0.0001), total protein levels did not show significant variation in comorbidities group. Additionally, moderate disease severity was strongly associated with longer hospital stays (p-value 0.0001).
Conclusion: Several factors, including abnormal biomarkers and moderate case severity, were identified as potential influences on nutritional risk at hospital admission and its long-term effects on COVID-19 survivors.
References
1. Janiaud P, Axfors C, van’t Hooft J, et al. The worldwide clinical trial research response to the COVID 19 pandemic the first 100 days. F1000Research. 2020;9: 1193. doi: 10.12688/f1000research.26707.2.
2. Myoung J. Two years of COVID 19 pandemic: where are we now? J Microbiol. 2022;60(3): 235–237. doi: 10.1007/s12275 022 1679 x.
3. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID 19 in the New York City area. JAMA. 2020;323(20): 2052. doi: 10.1001/jama.2020.6775.
4. Calder P, Carr A, Gombart A, Eggersdorfer M. Optimal nutritional status for a well functioning immune system is an important factor to protect against viral infections. Nutrients. 2020;12(4): 1181. doi: 10.3390/nu12041181.
5. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID 19) outbreak in China. JAMA. 2020;323(13): 1239. doi: 10.1001/jama.2020.2648.
6. Hu B, Guo H, Zhou P, Shi ZL. Characteristics of SARS CoV 2 and COVID 19. Nat Rev Microbiol. 2021;19(3): 141–154. doi: 10.1038/s41579 020 00459 7.
7. Dhama K, Khan S, Tiwari R, et al. Coronavirus disease 2019–COVID 19. Clin Microbiol Rev. 2020;33(4). doi: 10.1128/CMR.00028 20.
8. Abate SM, Chekole YA, Estifanos MB, Abate KH, Kabthymer RH. Prevalence and outcomes of malnutrition among hospitalized COVID 19 patients: a systematic review and meta analysis. Clin Nutr ESPEN. 2021;43: 174–183. doi: 10.1016/j.clnesp.2021.03.002.
9. Mancin S, Bertone A, Cattani D, al. Malnutrition risk as a negative prognostic factor in COVID 19 patients. Clin Nutr ESPEN. 2021;45: 369–373. doi: 10.1016/j.clnesp.2021.07.016.
10. Di Filippo L, De Lorenzo R, D’Amico M, et al. COVID 19 is associated with clinically significant weight loss and risk of malnutrition, independent of hospitalisation: a post hoc analysis of a prospective cohort study. Clin Nutr. 2021;40(4): 2420–2426. doi: 10.1016/j.clnu.2020.10.043.
11. Arab Zozani M, Hashemi F, Safari H, Yousefi M, Ameri H. Health related quality of life and its associated factors in COVID 19 patients. Osong Public Health Res Perspect. 2020;11(5): 296–302. doi: 10.24171/j.phrp.2020.11.5.05.
12. Wierdsma NJ, Kruizenga HM, Konings LAML, et al. Poor nutritional status, risk of sarcopenia and nutrition related complaints are prevalent in COVID 19 patients during and after hospital admission. Clin Nutr ESPEN. 2021;43: 369–376. doi: 10.1016/j.clnesp.2021.03.021.
13. Katona P, Katona Apte J. The interaction between nutrition and infection. Clin Infect Dis. 2008;46(10): 1582–1588. doi: 10.1086/587658.
14. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID 19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229): 1054–1062. doi: 10.1016/S0140 6736(20)30566 3.
15. James PT, Ali Z, Armitage AE, et al. The role of nutrition in COVID 19 susceptibility and severity of disease: a systematic review. J Nutr. 2021;151(7): 1854–1878. doi: 10.1093/jn/nxab059.
16. Yeo HJ, Byun KS, Han J, et al. Prognostic significance of malnutrition for long term mortality in community acquired pneumonia: a propensity score matched analysis. Korean J Intern Med. 2019;34(4): 841–849. doi: 10.3904/kjim.2018.037.
17. Bedock D, Bel Lassen P, Mathian A, et al. Prevalence and severity of malnutrition in hospitalized COVID 19 patients. Clin Nutr ESPEN. 2020;40: 214–219. doi: 10.1016/j.clnesp.2020.09.018.
18. Venter C, Eyerich S, Sarin T, Klatt KC. Nutrition and the immune system: a complicated tango. Nutrients. 2020;12(3): 818. doi: 10.3390/nu12030818.
19. Zabetakis I, Lordan R, Norton C, Tsoupras A. COVID 19: the inflammation link and the role of nutrition in potential mitigation. Nutrients. 2020;12(5): 1466. doi: 10.3390/nu12051466.
20. Yu Y, Ye J, Chen M, et al. Malnutrition prolongs the hospitalization of patients with COVID 19 infection: a clinical epidemiological analysis. J Nutr Health Aging. 2021;25(3): 369–373. doi: 10.1007/s12603 020 1541 y.
21. Spolidoro GCI, Azzolino D, Shamir R, Cesari M, Agostoni C. Joint effort towards preventing nutritional deficiencies at the extremes of life during COVID 19. Nutrients. 2021;13(5): 1616. doi: 10.3390/nu13051616.
22. Kurtz A, Grant K, Marano R, et al. Long term effects of malnutrition on severity of COVID 19. Sci Rep. 2021;11(1): 14974. doi: 10.1038/s41598 021 94138 z.
23. Li T, Zhang Y, Gong C, et al. Prevalence of malnutrition and analysis of related factors in elderly patients with COVID 19 in Wuhan, China. Eur J Clin Nutr. 2020;74(6): 871–875. doi: 10.1038/s41430 020 0642 3.
24. Diagnosis and treatment protocol for COVID‐19 patients (Trial Version 9). Health Care Sci. 2022;1(1): 14–28. doi: 10.1002/hcs2.1.
25. Agarwal A, Hunt BJ, Stegemann M, et al. A living WHO guideline on drugs for COVID 19. BMJ. 2020; m3379. doi: 10.1136/bmj.m3379.
26. Skipper A, Coltman A, Tomesko J, et al. Adult malnutrition (undernutrition) screening: an Evidence Analysis Center systematic review. J Acad Nutr Diet. 2020;120(4): 669–708. doi: 10.1016/j.jand.2019.09.010.
27. Espiritu AI, Reyes NGD, Leochico CFD, et al. Body mass index and its association with COVID 19 clinical outcomes: findings from the Philippine CORONA study. Clin Nutr ESPEN. 2022;49: 402–410. doi: 10.1016/j.clnesp.2022.03.013.
28. Sattar N, Ho FK, Gill JMR, et al. BMI and future risk for COVID 19 infection and death across sex, age and ethnicity: preliminary findings from UK Biobank. Diabetes Metab Syndr Clin Res Rev. 2020;14(5): 1149–1151. doi: 10.1016/j.dsx.2020.06.060.
29. Mohammadi P, Varpaei HA, Khafaee pour khamseh A, Mohammadi M, Rahimi M, Orandi A. Evaluation of the relationship between nutritional status of COVID 19 patients admitted to the ICU and patients’ prognosis: a cohort study. J Nutr Metab. 2022;2022: 1–8. doi: 10.1155/2022/5016649.
30. Cederholm T, Barazzoni R, Austin P, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017;36(1): 49–64. doi: 10.1016/j.clnu.2016.09.004.
31. Gao M, Piernas C, Astbury NM, et al. Associations between body mass index and COVID 19 severity in 6·9 million people in England: a prospective, community based, cohort study. Lancet Diabetes Endocrinol. 2021;9(6): 350–359. doi: 10.1016/S2213 8587(21)00089 9.
32. Feng X, Liu Z, He X, et al. Risk of malnutrition in hospitalized COVID 19 patients: a systematic review and meta analysis. Nutrients. 2022;14(24): 5267. doi: 10.3390/nu14245267.
33. Green SB. How many subjects does it take to do a regression analysis. Multivar Behav Res. 1991;26(3): 499–510. doi: 10.1207/s15327906mbr2603_7.
34. Soeroto AY, Soetedjo NN, Purwiga A, et al. Effect of increased BMI and obesity on the outcome of COVID 19 adult patients: a systematic review and meta analysis. Diabetes Metab Syndr Clin Res Rev. 2020;14(6): 1897–1904. doi: 10.1016/j.dsx.2020.09.029.
35. Liu S, Zhang L, Weng H, et al. Association between average plasma potassium levels and 30 day mortality during hospitalization in patients with COVID 19 in Wuhan, China. Int J Med Sci. 2021;18(3): 736–743. doi: 10.7150/ijms.50965.
36. Aziz PY, Hadi JM, Sha AM, et al. The strategy for controlling COVID 19 in Kurdistan Regional Government (KRG)/Iraq: identification, epidemiology, transmission, treatment, and recovery. Int J Surg Open. 2020;25: 41–46. doi: 10.1016/j.ijso.2020.06.006.
37. Ahmad S. A review of COVID 19 (Coronavirus Disease 2019) diagnosis, treatments and prevention. Eurasian J Med Oncol. 2020; doi: 10.14744/ejmo.2020.90853.
38. Noori M, Nejadghaderi SA, Sullman MJM, Carson Chahhoud K, Kolahi A, Safiri S. Epidemiology, prognosis and management of potassium disorders in Covid 19. Rev Med Virol. 2022;32(1). doi: 10.1002/rmv.2262.
39. Bozkurt FT, Tercan M, Patmano G, Bingol Tanrıverdi T, Demir HA, Yurekli UF. Can ferritin levels predict the severity of illness in patients with COVID 19? Cureus. 2021; doi: 10.7759/cureus.12832.
40. Shoenfeld Y. Corona (COVID 19) time musings: our involvement in COVID 19 pathogenesis, diagnosis, treatment and vaccine planning. Autoimmun Rev. 2020;19(6): 102538. doi: 10.1016/j.autrev.2020.102538.
41. Moreira AC, Mesquita G, Gomes MS. Ferritin: an inflammatory player keeping iron at the core of pathogen host interactions. Microorganisms. 2020;8(4): 589. doi: 10.3390/microorganisms8040589.
42. Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7): 934. doi: 10.1001/jamainternmed.2020.0994.
43. Lechuga GC, Morel CM, De Simone SG. Hematological alterations associated with long COVID 19. Front Physiol. 2023;14. doi: 10.3389/fphys.2023.1203472.
44. Shang W, Dong J, Ren Y, et al. The value of clinical parameters in predicting the severity of COVID 19. J Med Virol. 2020;92(10): 2188–2192. doi: 10.1002/jmv.26031.
45. Ali AM, Kunugi H. Hypoproteinemia predicts disease severity and mortality in COVID 19: a call for action. Diagn Pathol. 2021;16(1): 31. doi: 10.1186/s13000 021 01092 5.
46. Alimohamadi Y, Mansouri Yekta E, Sepandi M, Sharafoddin M, Arshadi M, Hesari E. Hospital length of stay for COVID 19 patients: a systematic review and meta analysis. Multidiscip Respir Med. 2022;17. doi: 10.4081/mrm.2022.856.
47. Alwafi H, Naser AY, Qanash S, et al. Predictors of length of hospital stay, mortality, and outcomes among hospitalised COVID 19 patients in Saudi Arabia: a cross sectional study. J Multidiscip Healthc. 2021;14: 839–852. doi: 10.2147/JMDH.S304788.
48. Simón Frapolli VJ, López Montalbán Á, Vegas Aguilar IM, et al. Relationship between vitamin D levels with in hospital complications and morphofunctional recovery in a cohort of patients after severe COVID 19 across different obesity phenotypes. Nutrients. 2024;17(1): 110. doi: 10.3390/nu17010110.
49. van Raaij BFM, Noordam R, Smits RAL, et al. Preparing for future pandemics: frailty associates with mortality in hospitalised older people during the entire COVID 19 pandemic, a Dutch multicentre cohort study. Eur Geriatr Med. 2024;15(4): 951–959. doi: 10.1007/s41999 024 01001 1.
50. Santos Ribeiro C, Rodríguez Blázquez C, Ayala A, Romay Barja M, Falcón M, Forjaz MJ. Evolution of Spanish population well being during the COVID 19 pandemic: results from the COSMO Spain study. Heliyon. 2025;11(3): e42409. doi: 10.1016/j.heliyon.2025.e42409.
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