Malnutrition Contributes to Low Lymphocyte Count in Early-Stage Coronavirus Disease-2019

Background and Aim: Lymphocytes play an important role in fighting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Low total lymphocyte count (TLC), which contributes to poor clinical outcomes, is common in persons with coronavirus disease 2019 (COVID-19). The current explanation for the cause of low TLC is that it is directly related to the invasiveness of SARS-CoV-2, which attacks lymphocytes. We hypothesized that malnutrition contributes to the development of low TLC in early-stage COVID-19.Methods: We prospectively enrolled 101 patients with confirmed COVID-19. On their first day of hospitalization, we collected baseline and laboratory data, including clinical symptoms; the Sequential Organ Failure Assessment, Nutrition Risk Screening 2002 and Subjective Global Assessment were used to assess the malnutrition status of the patients. Multivariable logistic regression was used to identify independent risk factors for low TLC and severe COVID-19.Results: Malnutrition was associated with lower TLC in COVID-19. Fifty-nine (58.4%) of the patients showed low TLC, 41 (40.6%) were at risk for malnutrition, and 18 of them were malnourished. Low TLC was an independent risk factor for severe COVID-19. Compared to patients with normal TLC, those with low TLC more often presented with anorexia, malnutrition, higher SOFA scores (P < 0.05) and comorbidities (diabetes and malignancies). Malnutrition (OR: 3.05, 95% CI: 1.5–6.19, P = 0.006) and SOFA scores (OR: 1.51, 95% CI: 1.04-2.43, P = 0.042) were identified as independent risk factors for low TLC.Conclusions: Malnutrition was common among our patients with early-stage COVID-19, and it contributed to the occurrence of low TLC.

Use of mNUTRIC-Score for Nutrition Risk Assessment and Prognosis Prediction in Critically Ill Patients with COVID-19: A Retrospective Observational Study

Introduction. Nutritional risk is highly prevalent in patients with COVID-19. Relevant data on nutritional assessment in the critically ill population are scarce. This study was conducted to evaluate the modified Nutrition Risk in the Critically Ill (mNUTRIC)-Score as a mortality risk factor in mechanically ventilated patients with COVID-19. Methods. We conducted this retrospective observational study in critically ill patients with COVID-19. Patients’ characteristics and clinical information were obtained from electronic medical records. The nutritional risk for each patient was assessed at the time of mechanical ventilation using the mNUTRIC-Score. The major outcome was 28-day mortality. Results. Ninety-eight patients were analyzed (mean age, 57.22 ± 13.66 years, 68.4% male); 46.9% of critically ill COVID-19 patients were categorized as being at high nutrition risk (mNUTRIC-Score of ≥5). A multivariate logistic regression model indicated that high nutritional risk has higher 28-day hospital mortality (OR = 4.206, 95% CI: 1.147–15.425, p = 0.030 ). A multivariate Cox regression analysis showed that high-risk mNUTRIC-Score had a significantly increased full-length mortality risk during hospitalization (OR = 1.991, 95% CI: 1.219–3.252, p = 0.006 ). Conclusion. The mNUTRIC-Score is an independent mortality risk factor during hospitalization in critically ill COVID-19 patients.

The mNUTRIC Score as a Tool to Predict Mortality and Increased Resource Utilization in Intensive Care Patients with Sepsis.

Background: The mNUTRIC score is a nutrition risk assessment tool. The aim of this study was to evaluate mNUTRIC score ability to predict 28-mortality, icu resource utilization and nursing workload for patients with sepsis and septic shock. Methods: We performed a secondary analysis of prospectively collected data from a ICU sepsis registry database. The study included adults diagnosed with sepsis or septic shock, admitted from January to December 2014.Results: The study included 146 patients. In the ROC curve analysis the mNUTRIC score had the ability to predict 28-day mortality with an AUC of 0.833 (95% CI 0.76-0.89). Additionally group of patients with NUTRIC score ≥ 6 points more frequently required vasopressor infusion, mechanical ventilation, renal replacement therapy, thromboprophylaxis and blood products use. Nursing workload was also significantly higher in this group (TISS-28: 36 pts., IQR 33 – 40 vs. 31 pts, IQR 28 – 34, p<0.001).Conclusion: The mNUTRIC score obtained at admission to the ICU provided a good discriminative value for 28-mortality and makes it possible to identify patients who will ultimately require intense use of ICU resources with an associated increase in the nursing workload during ICU sepsis treatment.

Development and Validation of Self-screening Tool for Nutrition Risk in Patients With Gastric Cancer After Gastrectomy: A STUDY PROTOCOL

Background: The incidence of malnutrition in patients with gastric cancer after surgery is 59%. The main reason for the high incidence of malnutrition is untimely nutrition screening and low compliance with nutrition treatment. In order to enable home patients to know their nutritional status in time, we have developed and validated nutritional risk screening tools for patients with gastric cancer to help patients’ at home find nutritional risks in time and seek medical help. This article introduces the development and verification methods and statistical methods of the tool.Methods: The development of self-nutrition risk screening tool for patients with gastric cancer after gastrectomy (SNRSGC) is divided into four parts：Steps1Identification of a potential referred nutritional risk screening; Steps2Item generation and scoring are selected through literature review methods to screen sensitive indicators that can reflect the nutritional characteristics of patients after gastric cancer surgery, establish the frame and update according to the latest guidelines ；Steps3Item reduction is determined by the rating of SNRSGC items by an expert panel and piloting method to determine the final item; Steps4 In the validation stage, we conducted research design based on the Consensus-based Standards for the selection of health Measurement Instruments checklist to evaluate the content validity, structure validity, interpretability, and retest validity of SNRSGC.Discussion: SNRSGC is the first screening tool specifically to predict nutrition risk for stay-at-home postoperative patients with gastric cancer.SNRSGC may provide action guidelines and knowledge guidance for patients with gastric cancer at home.Trial registration: Identifier on Chinese Clinical Trials Registry : ChiCTR2100041809 , registered January 06, 2021.

Prognostic Utility of Geriatric Nutritional Risk Index After Curative Resection of Colorectal Cancer: A Propensity Score-matched Study

Background/Aim: The geriatric nutrition risk index (GNRI) is a presumptive prognosticator in a variety of carcinomas. We investigated whether it similarly predicts outcomes of elderly patients with colorectal cancer (CRC). Patients and Methods: A total of 904 older adults (≥65 years) undergoing radical resections of CRC between April 2011 and December 2015 proved eligible for study. Each was grouped by preoperative status (cut-off point, 98) as low-level or normal GNRI, using propensity score matching to compare rates of complications, disease-free survival (DFS), and overall survival (OS). Results: After matching (n=127, each group), those with low-level (vs. normal) GNRI values experienced significantly more complications (p=0.001), and 5-year survival was significantly poorer (DFS: p=0.006; OS: p=0.002). Conclusion: In elderly patients with resected CRC, preoperative GNRI may have significant prognostic merit.

The Development of a Nutrition Screening Tool for Mental Health Settings Prone to Obesity and Cardiometabolic Complications: Study Protocol for the NutriMental Screener

People living with serious mental illness (SMI) experience physical health complications at disproportionate rates to people without an SMI. Unhealthy dietary intake and disordered eating behaviors are key driving factors. There is a lack of valid nutrition-risk screening tools targeted to mental health services, and typically used nutrition-risk screening tools are not suitable for mental health services. This paper details the rationale and study protocol for development and validation of the NutriMental screener, a tool for use in clinical practice to identify service users who are at risk for common nutrition issues experienced by this population group and trigger referral to a specialist clinician. The development process includes five phases. Phase I is the development of nutrition-related domains of interest from screening tools used in mental health services. Phase II involves a literature review and service-user interviews to identify additional domains. Phase III consists of international workshops with relevant clinicians and persons with SMI to gain a consensus on questions to be included in the draft tool. Phase IV involves conducting multinational feasibility and preliminary validation studies. Phase V consists of performing formal validation studies. The development of a nutrition-risk screening tool for mental health services is a necessary step to help rectify the physical-health disparities and life-expectancy gap for people with SMI.