Nutritional Risk Screening and Body Composition in COVID‐19 Patients Hospitalized in an Internal Medicine Ward

Figures & data

Table 1 Baseline Characteristics of 90 Patients Admitted to an Internal Medicine Ward for COVID-19

Characteristics	Total
Age, years	64.5 ± 13.7
Gender, females	29 (32.2)
Body mass index, kg/m^2	27.1 ± 4.0
SBP, mmHg	133.1 ± 20.3
DBP, mmHg	79.0 ±10.9
Heart rate, beats/sec	86.3±15.61
Breathing rate	21.8 ± 5.6
Hemoglobin, g/L	141.7 ± 16.9
Fasting glucose, mmol/l	7.3 ± 2. 5
ESW	5.5 ± 2.9
Creatinine, µmol/L	103.9 ± 111.9
Sodium, mmol/L	136.6 ± 3.5
Potassium, mmol/L	3.8 ± 0.44
Calcium, mmol/L	2.19 ± 0.11
C-reactive protein, mg/L	89.0 ± 71.5
CVD, %	27 (30.0)
Diabetes mellitus, %	9 (10.0)
Hypertension, %	32 (35.6)
PhA, °	5.6 ± 1.14
TBW, L/m	25.5 ± 4.2
Fat-free mass, kg	58.2 ± 10.7
Fat-free mass index, kg/m	34.3 ± 6.0
Fat mass, kg	21.1± 9.1
Fat mass, kg/m	12.4 ± 5.4
BCM, kg/m	17.8±4.7
NRS-2002	4.4 ± 1.27
Length of hospital stay, days	16.4 ± 14.9
Prolonged hospitalization, n %	19(21)
In-hospital deaths or ICU needing, n (%)	18(20)
Loss of appetite, (n %)	28 (31%)

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; ESW, early warning score; CVD, cardiovascular diseases; PhA, phase angle; TBW, total body water; BCM, body cell mass; ICU, intensive care unit; NRS, nutritional risk screening.

Figure 1 Risk groups’ comparison between NRS-2002 and BIA parameters. The percentage of the group found to be at risk varied significantly between NRS-2002, PhA, FFM, FM and BCM (p < 0.001).

Table 2 Body Composition and Nutritional Risk Screening According to Outcomes Under Study

Characteristics	Combined Outcomes		p-value	Prolonged Hospitalization		p-value	Loss of Appetite		p-value
PhA,°	5.7 ± 4 1.1	5.4 ± 1.3	0.386	5.7 ± 1.1	5.2 ± 1.3	0.1094	5.5± 1.1	5.8 ± 1.1	0.286
R, Ω	495.9 ± 87.2	484.7 ± 111.2	0.648	490.7 ± 90.5	504.6 ± 98.9	0.562	499.2 ± 101.7	481.4 ± 65.1	0.398
XC, Ω	48.5 ± 9.8	44.8 ± 11.3	0.175	48.4 ± 10.1	45.3 ± 10.1	0.243	47.4 ± 10.6	48.5 ± 9.2	0.654
TBW (%)	54.8 ± 7.0	55.3 ± 7.4	0.787	55.1 ± 7.3	54.1 ± 6.2	0.578	55.4 ± 7.29	53.8 ± 6.8	0.320
ECW (%)	47.5 ± 6.6	49.6 ± 7.1	0.254	47.3 ± 6.5	50.5 ± 7.4	0.066	48.3 ± 7.3	47.2 ± 5.3	0.508
Hydration (TBW/FFM), %	74.3 ± 2.7	75.2 ± 3.2	0.204	74.3 ± 2.3	75.2 ± 4.2	0.226	74.6 ± 3.0	74.2 ± 2.1	0.546
Fat-free mass, kg/m	12.4 ± 5.3	12.5 ± 5.93	0.921	12.2 ± 5.5	13.1 ± 4.9	0.520	11.9 ± 5.2	13.4 ± 5.9	0.233
Fat-free mass index, kg/m	33.9 ± 4.9	35.8 ± 9.4	0.253	34.1 ± 5.2	34.8 ± 8.6	0.658	34.3 ± 6.8	34.1 ± 4.2	0.888
BCM, Kg	17.6 ± 3.9	18.9 ± 6.9	0.297	18.2 ±4.8	16.4 ± 4.4	0.143	17.8 ± 5.2	17.9 ± 3.5	0.920
NRS-2002	4.3± 1.3	4.9 ± 0.8	0.095	4.4 ± 1.4	4.7 ± 0.9	0.352	4.1 ± 3.8	5.2 ± 0.8	<0.001

Abbreviations: PhA, phase angle; ECW, extracellular water; TBW, total body water; NRS-2002, Nutritional Risk Screening 2002; BCM, body cell mass.

Table 3 ROC Curves in Predicting Clinical Outcomes, Prolonged Hospitalization and Loss of Appetite According to NRS and Bioimpedance Parameters

	Composite Outcome				Prolonged Hospitalization				Loss of Appetite
	Sensitivity	Specificity	AUC (95% CI)	p-value	Sensitivity	Specificity	AUC (95% CI)	p-value	Sensitivity	Specificity	AUC (95% CI)	p-value
NRS-2002	100	0.217	0.549 (0.514–0.583)	0.911	100	0.229	0.549 (0.514–0.584)	0.991	100	0.337	0.556 (0.517–0.596)	0.991
PhA	0.835	0.454	0.597 (0.486–0.708)	0.033	0.823	0.455	0.589 (0.483–0.696)	0.045	0.909	0.342	0.563 (0.505–0.621)	0.125
FM	0.802	0.214	0.507 (0.409–0.605)	0.884	0.857	0.224	0.532 (0.448–0.615)	0.500	0.714	0.316	0.509 (0.429–0.590)	0.823
FFM	0.803	0.214	0.507 (0.409–0.605)	0.884	0.857	0.224	0.532 (0.448–0.615)	0.500	0.786	0.329	0.535 (0.460–0.611)	0.399
BCM	0.846	0.208	0.521 (0.435–0.607)	0.654	0.818	0.385	0.575 (0.467–0.683)	0.107	0.923	0.351	0.579 (0.518–0.640)	0.08

Abbreviations: ROC, receiver operating characteristics; AUC; area under the curve; NRS-2002, Nutritional Risk Screening 2002; PhA, phase angle; FM, fat mass; FFM, fat-free mass; BCM, body cell mass.

Table 4 Linear Regression Exploring the Correlation Between NRS-2002, Bioimpedance Parameters and Length of Hospitalization

Model 1-Unadjusted
	Beta Coefficient	Standard Error	p-value
NRS-2002 ≥3	12.62	5.79	0.030*
PhA ≤15th percentile	8.39	4.79	0.083
FM ≤15th percentile	−2.66	4.35	0.558
FFM ≤15th percentile	−5.37	4.37	0.222
BCM ≤15th percentile	2.57	4.54	0.573
Model 2-Adjusted
NRS-2002 ≥3	12.82	5.96	0.038*
PhA ≤15th percentile	4.77	4.92	0.335
FM ≤15th percentile	−4.87	4.81	0.313
FFM ≤15th percentile	−7.87	5.72	0.173
BCM ≤15th percentile	0.93	4.69	0.843

Notes: Model 2 is adjusted for age, sex, BMI, hypertension, diabetes, cardiovascular diseases, early warning score, serum glucose; *p-value <0.05.

Abbreviations: NRS-2002, Nutritional Risk Screening 2002; PhA, phase angle; FM, fat mass; FFM, fat-free mass; BCM, body cell mass.

Table 5 Multivariate Regression Analysis of NRS and Bioimpedance Parameters for Clinical Outcomes in Patients with COVID-19

Model 1-Unadjusted
	Combined Outcomes		Prolonged Hospitalization		Loss of Appetite
	OR (95% CI)	p value	OR (95% CI)	p value	OR (95% CI)	p value
NRS	1.54 (0.90.2.65)	0.110	1.24 (0.78–1.96)	0.362	3.07 (1.65–5.68)	≤0.001*
PhA	0.50(0.24–1.06)	0.071	1.48 (0.15–14.62)	0.735	2.08 (0.95–4.53)	0.066
FM	0.96(0.86–1.07)	0.471	0.99 (0.89–1.11)	0.990	1.12 (0.99–1.25)	0.051
FFM	1.06 (0.96–1.18)	0.243	1.20 (0.68–2.12)	0.532	0.96 (0.85–1.09)	0.513
BCM	1.14 (0.96–1.37)	0.124	0.69 (0.22–2.16)	0.524	0.89 (0.71–1.13)	0.364
Model 2-Adjusted
NRS	1.68 (0.59–4.72)	0.326	1.13 (0.62–2.06)	0.702	7.33 (2.62–20.47)	≤0.001*
PhA	0.59 (0.21–1.71)	0.332	1.04 (0.12–8.63)	0.974	2.53 (0.38–16.74)	0.334
FM	0.65 (0.44–0.97)	0.036	1.13 (0.86–1.48)	0.396	0.93 (0.72–1.21)	0.613
FFM	0.84 (0.68–1.05)	0.152	1.17 (0.60–2.25)	0.650	0.94 (0.65–1.35)	0.742
BCM	1.28 (0.96–1.72)	0.093	0.95 (0.32–2.84)	0.932	0.71 (0.29–1.68)	0.435
Gender, females	1.23 (0.08–19.53)	0.881	4.32 (0.25–76.0)	0.317	0.54 (0.04–6.43)	0.622
Age	0.96 (0.88–1.06)	0.484	1.00 (0.94–1.08)	0.930	0.92 (0.86–0.99)	0.027*
ESW	1.59 (1.06–2.39)	0.026*	1.09 (0.85–1.39)	0.498	1.07 (0.83–1.39)	0.602
Glucose	2.80 (1.41–5.53)	≤0.001*	1.73 (1.06–2.83)	0.028*	0.99 (0.69–1.42)	0.947
CRP	1.00 (0.99.1.01)	0.609	0.99 (0.99–1.00)	0.610	0.99 (0.99–1.00)	0.483
Hemoglobin	0.95 (0.88–1.03)	0.185	1.04 (0.98–1.10)	0.259	0.97 (0.92–1.02)	0.236
BMI	1.53 (0.95–2.45)	0.080	0.79 (0.52–1.18)	0.243	1.26 (0.86–1.85)	0.231
Hypertension	0.58 (0.09–3.64)	0.564	1.22 (0.31–4.83)	0.773	0.28 (0.07–1.24)	0.094
CVD	2.94 (0.39–21.8)	0.292	1.44 (0.33–6.42)	0.626	1.08 (0.24–4.93)	0.914
Diabetes	0.35 (0.02–6.58)	0.484	2.18 (0.22–21.54)	0.504	1.26 (0.08–18.92)	0.865

Note: *p-value<0.05.

Abbreviations: NRS, nutritional risk score; PhA, phase angle; FM, fat mass; FFM, fat-free mass; BCM, body cell mass; EWS, early warning score; CRP, c-reactive protein; BMI, body mass index, CVD, cardiovascular diseases; TBW, total body water.