Nutritional Risk Score (NRS-2002) as a Predictor of In-Hospital Mortality in COVID-19 Patients: A Retrospective Single-Center Cohort Study

<b>Background</b>: Malnutrition is an often-overlooked yet potentially crucial factor influencing COVID-19 outcomes. Poor nutritional status weakens immune function, increases infection susceptibility, and worsens prognoses in hospitalized patients. However, its specific role in COVID-19 mortality remains insufficiently characterized. The aim of the study was to assess the impact of malnutrition, as determined by the Nutritional Risk Score (NRS-2002), on in-hospital mortality. <b>Methods</b>: This retrospective, single-center study analyzed 222 patients hospitalized with COVID-19 during the Delta variant predominance. Thirty-one patients died during hospitalization. Malnutrition (NRS ≥ 3) emerged as a strong predictor of in-hospital mortality in univariate Cox proportional hazard models, both before and after adjustment for potential confounders. Adjusted analyses used 10 different sets of three out of five mortality-related variables. <b>Results</b>: Hazard ratios for malnutrition ranged from 3.19 to 5.88 (<i>p</i> < 0.01 for all models), highlighting its substantial impact on mortality risk. The high Nagelkerke's R² values (0.66-0.77) indicate that the models explained a significant proportion of mortality variance. Nutritional status plays a critical role in COVID-19 survival among hospitalized patients. <b>Conclusions</b>: Given its simplicity and effectiveness, integrating the NRS-2002 into routine clinical assessments may help identify high-risk patients early. Future research should explore whether early nutritional interventions can mitigate the mortality risks associated with malnutrition in severe COVID-19 cases or patients with other infectious diseases or acute inflammation.