Nutritional Status at Admission and Clinical Outcomes in Hospitalized Patients with COVID-19: Results from the MODIeCOSe in Italy Study

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Abstract
Background/Objectives: Poor nutritional status is common among hospitalized patients and may adversely affect the response to severe acute illness. We investigated the association between nutritional status at hospital admission and clinical outcomes in patients hospitalized with COVID-19 during the first two pandemic waves in Italy. Methods: This retrospective multicenter study included 1187 patients hospitalized with COVID-19 across nine Italian centers participating in the MODIeCOSe in Italia registry. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score, the Prognostic Nutritional Index (PNI), and available anthropometric measures. The primary outcome was a composite of in-hospital death or transfer to an intensive care unit (ICU). Multivariable logistic regression was used to assess the independent association between nutritional status and outcome. Results: Overall, 275 patients (23.2%) experienced the composite adverse outcome. CONUT score was higher in patients with an adverse than in those with a favorable outcome (4.4 ± 2.3 vs. 3.4 ± 1.8; p < 0.001), whereas PNI did not differ significantly. Patients with an adverse outcome also had lower body weight, BMI, waist circumference, and waist-to-height ratio, although anthropometric data were available only in subsets of the cohort. In the main multivariable model adjusted for admission PaO2/FiO2 and relevant clinical covariates, higher CONUT remained independently associated with adverse outcome (OR 1.65, 95% CI 1.12–2.45 per 1-SD increase; p = 0.01). The association was similar in a sensitivity analysis excluding PaO2/FiO2 (OR 1.79, 95% CI 1.28–2.49; p < 0.001). Conclusions: A higher CONUT score at admission was independently associated with an increased risk of in-hospital death or ICU transfer, supporting its prognostic relevance as an immuno-nutritional index in hospitalized patients with COVID-19.

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