The relationship between the prognostic nutritional index and the clinical course of COVID-19: a single-center experience

Year 2022, Volume: 3 Issue: 2, 92 - 97, 28.06.2022

Kadem Arslan , Süleyman Baş

https://doi.org/10.47582/jompac.1110431

Cited By: 4

Abstract

Aim: It was aimed to investigate the relationship between the prognostic nutritional index (PNI) and the clinical course in COVID-19 because the nutritional status is important in defense against infection.
Material and Method: 1579 patients who applied to the hospital inpatient clinic between 01/04/2020 and 30/11/2020 were included in the study. The PNI scores of the patients were calculated at the time of admission to the hospital. Comparisons were made between PNI scores of the patients and intensive care unit admission status, treatment results, length of hospital stay, and presence of pneumonia on thorax CT. Moreover, comparisons were made between PNI scores and C-reactive protein (CRP), neutrophil/ymphocyte ratio (NLR), CRP/albumin ratio.
Results: A total of 1579 patients (755 females and 824 males) were included in the study. The rate of admission to the ICU was significantly higher in males. The mortality rate of the study group was 9.4%. PNI scores were found to be significantly lower in patients who died and in patients admitted to the ICU. CRP and CRP/albumin ratio levels were significantly higher in patients with pneumonia on thorax CT, in patients admitted to the intensive care unit, and in patients who died. There were a significant negative correlation between PNI score and CRP/albumin ratio levels.
Conclusion: PNI scores were found to be significantly lower in patients who needed admission to the intensive care unit and died due to severe COVID-19 than the others. In patients with a low PNI score, COVID-19 can be more severe and it may cause worse clinical outcomes.

Keywords

COVID-19, CRP/albumin ratio, neutrophil/lymphocyte ratio, prognostic nutritional index

Prognostik nütrisyonel indeks ve COVID-19 klinik seyri arasındaki ilişki: tek merkez deneyimi

Abstract

Amaç: Enfeksiyona karşı savunmada beslenme durumunun önemli olması nedeniyle COVID-19’da prognostik beslenme indeksi (PNI) ile klinik seyir arasındaki ilişkinin araştırılması amaçlandı.
Gereç ve Yöntem: 01/04/2020-30/11/2020 tarihleri arasında hastaneye başvuran 1579 hasta çalışmaya dahil edildi. Hastaların hastaneye başvuru anında PNI skorları hesaplandı. Hastaların PNI skorları ile yoğun bakıma yatış durumu, tedavi sonuçları, hastanede kalış süreleri ve toraks BT’de pnömoni varlığı arasında karşılaştırmalar yapıldı. Ayrıca PNI skorları ile C-reaktif protein (CRP), nötrofil/imfosit oranı (NLR), CRP/albumin oranı arasında karşılaştırmalar yapıldı.
Bulgular: Çalışmaya toplam 1579 hasta (755 kadın ve 824 erkek) dahil edildi. Erkeklerde yoğun bakıma kabul oranı anlamlı olarak daha yüksekti. Çalışma grubunun mortalite oranı %9,4’tü. Ölen hastalarda ve yoğun bakım ünitesine kabul edilen hastalarda PNI skorları anlamlı olarak daha düşük bulundu. Toraks BT’sinde pnömoni olan hastalarda, yoğun bakıma yatırılan hastalarda ve ölen hastalarda CRP ve CRP/albümin oranı anlamlı olarak daha yüksekti. PNI skoru ile CRP/albümin oranı arasında anlamlı negatif korelasyon vardı.
Sonuç: Şiddetli COVID-19 nedeniyle yoğun bakım ünitesine yatırılması gereken ve ölen hastalarda PNI skorları anlamlı derecede daha düşük bulundu. PNI skoru düşük olan hastalarda COVID-19 daha şiddetli seyredebilir ve daha kötü klinik sonuçlara neden olabilir.

Keywords

COVID-19, CRP/albümin oranı, nötrofil/lenfosit oranı, prognostik beslenme indeksi

References

• Ozcelik F, Tanoglu A, Guven BB, Keskin U, Kaplan M. Assessment of severity and mortality of COVID-19 with anti-A1 and anti-B IgM isohaemagglutinins, a reflection of the innate immune status. Int J Clin Pract 2021; 75: e14624.
• Güven BB, Ertürk T, Yıldız E, Durmayüksel E, Ersoy A, Tanoğlu A. Our convalescent plasma experiences in COVID-19 patients hospitalized in the intensive care unit. J Health Sci Med 2022; 5: 600-6.
• Arslan K, Baş S. Frequency of troponin elevations in patients with COVID-19 and clinical course in these patients. Anatolian Curr Med J 2022; 4: 95-102.
• Beck MA, Levander OA. Host nutritional status and its effect on a viral pathogen. J Infect Dis 2000; 182: S93–6.
• Isabel TM, Correia D, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 2003; 22: 235-9.
• Keskin M, Hayıroğlu MI, Keskin T, et al. A novel and useful predictive indicator of prognosis in ST‐segment elevation myocardial infarction, the prognostic nutritional index. Nutrition, Metabolism, Cardiovas Dis 2017; 27: 438‐46.
• Cheng YL, Sung SH, Cheng HM, et al. Prognostic nutritional index and the risk of mortality in patients with acute heart failure. J Am Heart Assoc 2017; 6.
• Li D, Yuan X, Liu J, Li C, Li W. Prognostic value of prognostic nutritional index in lung cancer: a meta-analysis. J Thorac Dis 2018; 10: 5298–307.
• Scrimshaw NS, SanGiovanni JP. Synergism of nutrition, infection, and immunity: an overview. Am J Clin Nutr 1997; 66: 464-77.
• Bresnahan KA, Tanumihardjo SA. Undernutrition, the acute phase response to infection, and its effects on micro nutrient status indicators. Adv Nutr 2014; 5: 702-11.
• Sun KY, Xu JB, Chen SL, et al. Novel immunological and nutritional-based prognostic index for gastric cancer. World J Gastroenterol 2015; 21: 5961-71.
• Shirakabe A, Hata N, Kobayashi N, et al. The prognostic impact of malnutrition in patients with severely decompensated acute heart failure, as assessed using the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score. Heart Vessels 2018; 33: 134-44.
• Kahraman S, Zencirkıran AH, Kalkan AK, et al. Prognostic nutritional index predicts mortality in infective endocarditis. Turk Kardiyol Dern Ars 2020; 48: 392-402.
• Moon SW, Lee EH, Choi JS, et al. Impact of prognostic nutritional index on outcomes in patients with Mycobacterium avium complex pulmonary disease. PLOS ONE 2020; 15: e0232714.
• Wang Z,Lin Y, Wei X, et al. Predictive value of prognostic nutritional index on COVID-19 severity. Front Nutr 2020; 7: 582736.
• Wang R, He M, Yin W, et al. The prognostic nutritional index is associated with mortality of COVID-19 patients in Wuhan, China. J Clin Lab Anal 2020; 34: e23566.
• Yıldırım A, Özcan Abacıoğlu Ö, Belibağlı MC. The impact of objective nutritional indexes on in-hospital mortality in COVID-19 infection. Cukurova Med J 2021; 46 : 724-31.
• Li X, Xu S, Yu M, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol 2020; 146: 110-8.
• Zhao Y, Qin L, Zhang P, et al. Exuberant elevation of IP-10,MCP-3 and IL-1ra during SARS-CoV-2 infection is associated with disease severity and fatal outcome. medRxiv 2020; 1-26.
• Peters SJ, Vanhaecke T, Papeleu P, Rogiers V, Haagsman HP, van Norren K. Co-culture of primary rat hepatocytes with rat liver epithelial cells enhances interleukin-6-induced acute-phase protein response. Cell Tissue Res 2010; 340: 451-7.
• Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan. JAMA 2020; 180: 934.
• Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol 2017; 39: 529-39.
• Luo X, Zhou W, Yan X, et al. Prognostic value of C-reactive protein in patients with COVID-19. Clin Infect Dis 2020; 71: 2174-9.
• Özdemir İH, Özlek B, Özen MB, et al. Prognostic value of C-reactive protein/albumin ratio in hypertensive COVID-19 patients. Clin Exp Hypertens 2021; 43: 683-9.
• Lucijanić M, Stojić J, Atić A, et al. Clinical and prognostic significance of C-reactive protein to albumin ratio in hospitalized coronavirus disease 2019 (COVID-19) patients : Data on 2309 patients from a tertiary center and validation in an independent cohort. Wien Klin Wochenschr 2022: 1–8.