Nutrition characteristics and clinical outcomes of hospitalised patients with COVID-19: A large retrospective cohort study

<h2>Abstract</h2><h3>Background & Aims</h3> Nutrition-related comorbidities and malnutrition contribute to adverse clinical outcomes in patients with COVID-19. This study aimed to describe the nutrition characteristics of hospitalised patients with COVID-19 throughout 2020–2021 and report associations with patient outcomes, including in-hospital mortality, Intensive Care Unit (ICU) admission and length of hospital stay (LOS). <h3>Methods</h3> Single-centre, retrospective cohort study including all patients who tested positive for COVID-19, admitted to an inpatient ward for >24 hours. Data were obtained by review of electronic medical records of adults (≥18-years) admitted over the study period. For subset analysis, patients were categorised in two ways: year (2020 vs. 2021) and those assessed by dietitian vs. not. <h3>Results</h3> 869 patients met inclusion criteria. Mean age was 56.1 (standard deviation ±19.4) years, majority (54%) were male, and median LOS was 6 days [interquartile range 3–11]. Where height and weight were available (n=222), mean Body Mass Index (BMI) was 32.1kg/m² (±7.7). Diabetes (odds ratio (OR): 2.2, <i>P</i>=0.01) and risk of malnutrition or malnutrition (OR 2.1, <i>P</i>=0.04) were both associated with in-hospital mortality. Odds of admission to ICU for individuals classed as obese were 3.5 times greater than those with a BMI <30 kg/m² (<i>P</i><0.001). Dietitians assessed 291 (34%) patients with COVID-19, of which 108 (36.7%) were identified as either at risk of malnutrition or malnourished. There was no significant difference in LOS for those assessed as at risk of malnutrition or malnourished across the whole cohort. However, subset analysis of the 2020 cohort, highlighted that median LOS was significantly longer (15 [7–21] vs. 4 [3–8] days, <i>P</i><0.001) in those who were assessed as at risk of malnutrition or malnourished. <h3>Conclusions</h3> Presence of diabetes, obesity and risk of malnutrition or malnutrition in individuals with COVID-19 were associated with worse clinical outcomes in this cohort. Nutrition assessment, with subsequent integrated metabolic and nutrition management is fundamental for prognostic and potentially disease-modification purposes.