The role of nutritional risk evaluation in predicting adverse outcomes among patients with severe COVID-19 in Vietnam

Lan Huong Thi Nguyen; Anh Kim Dang; Tien Viet Tran; Hai Thanh Phan; Dao Anh Thi Doan; Lien Bao Thi Nguyen; Anh Minh Tran; Tung Dinh Do; Thang Ba Nguyen; Tien Thanh Nguyen; Binh Huy Nguyen; Huong Thi Le

doi:10.3389/fnut.2023.1245816

The role of nutritional risk evaluation in predicting adverse outcomes among patients with severe COVID-19 in Vietnam

Front Nutr. 2023 Oct 5:10:1245816. doi: 10.3389/fnut.2023.1245816. eCollection 2023.

Authors

Affiliations

¹ School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
² Department of Nutrition, Saint Paul General Hospital, Hanoi, Vietnam.
³ Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, QLD, Australia.
⁴ Department of Nutrition, Thanh Nhan General Hospital, Hanoi, Vietnam.
⁵ Intensive Care Unit and Poison Control, Saint Paul General Hospital, Hanoi, Vietnam.
⁶ Saint Paul General Hospital, Hanoi, Vietnam.
⁷ Department of Physiology, Hanoi Medical University, Hanoi, Vietnam.

Abstract

Introduction: As sufficient nutrition helps alleviate catabolic stress and modulate the systemic inflammatory response of the body, it plays an indispensable role in the good prognosis of critically ill patients. Thus, this study aimed to investigate the malnutrition of patients with severe COVID-19 and its association with adverse treatment outcomes.

Methods: We conducted a retrospective cross-sectional study in two provincial hospitals in Hanoi from February to April 2022. Participants were patients with severe COVID-19 admitted to the Intensive Care Unit (ICU). Malnutrition risk were evaluated by Nutritional Risk Screening-2002 (NRS), Global Leadership Initiative on Malnutrition (GLIM), Prognostic Nutritional Index (PNI), and the adverse prognosis was assessed by Acute Physiology and Chronic Health Evaluation II (APACHE II). The multivariate receiver-operating characteristic (ROC) curve was applied to estimate the predictive ability of those criteria regarding worse treatment results.

Results: The percentages of malnutrition measured by NRS, GLIM, PNI, and BMI were 62.6, 51.5, 42.9, and 16.6%, respectively. Patients with more severe malnutrition assessed by GLIM, PNI, and having above target fasting blood glucose (FBG) (≥10.0 mmol/L) were more likely to have higher APACHE scores. PNI had a better diagnostic performance than NRS and BMI (AUC = 0.84, 0.81, and 0.82, respectively). In addition, FBG revealed a good prognostic implication (AUC = 0.84).

Conclusion: A relatively high percentage of patients experienced moderate and severe malnutrition regardless of screening tools. Individuals at higher risk of malnutrition and high FBG were predicted to have more adverse treatment outcomes. It is recommended that nutritional screening should be conducted regularly, and personalizing nutritional care strategies is necessary to meet patients' nutrient demands and prevent other nutrition-related complications.

Keywords: COVID-19; Nutritional Risk Screening (NRS); Prognostic Nutritional Index (PNI); The Global Leadership Initiative on Malnutrition (GLIM); Vietnam; nutritional status.