key: cord-0706004-pm1hf0z7 authors: Yuan, Yajun; Mao, Junjie; Ou, Xueqing; Huang, Lili; Tu, Qiuyun; Wang, Nan title: Geriatric Nutritional Risk Index assessment in elderly patients during the COVID‐19 outbreak date: 2022-04-13 journal: Health Sci Rep DOI: 10.1002/hsr2.560 sha: 1468963af42f1647b41899943dcd3c2dc4f7e9a8 doc_id: 706004 cord_uid: pm1hf0z7 BACKGROUND AND AIMS: Globally, coronavirus disease‐2019 (COVID‐19) is persistent in many countries and presents a major threat to public health. Critically, elderly individuals, especially those with underlying disease, poor nutritional and immune functions, are highly susceptible. Therefore, we analyzed the epidemiological features in elderly COVID‐19 patients. METHODS: In total, 126 patients were recruited in the Fifth Affiliated Hospital of Sun Yat‐sen University, China from January 2020 to March 2020 (including 103 confirmed COVID‐19 patients and 23 elderly suspected cases). Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. We assessed nutritional risks in elderly patients by calculating the Geriatric Nutritional Risk Index (GNRI). RESULTS: When compared with young patients, elderly patients were more likely to have underlying comorbidities and received nutritional support and intensive care unit treatment. Elderly patients had significantly lower levels of the following: lymphocyte percentages, red blood cell counts, hemoglobin levels, and serum albumin values. When compared with suspected COVID‐19 elderly cases, elderly patients had significantly lower red blood cell counts and hemoglobin levels. The average GNRI of suspected cases and confirmed patients indicated no nutritional risk. There were no marked differences in GNRI values between groups. CONCLUSION: Nutritional risk assessments may provide valuable information for predicting a COVID‐19 prognosis, especially in elderly patients. Anemia prevention and management should be actively and timely provided. GNRI is a potentially prognostic factor for hospitalized elderly patients. Moreover, it is also important to follow up discharged patients for continuous nutritional observations. Globally, COVID-19 is persistent in many countries and presents a major threat to public health. 1 Worldwide, more than 50 million cases have been confirmed. Most patients are elderly, with severe disease. [2] [3] [4] The elderly are more vulnerable patients because of immunosenescence and increased malnutrition rates. Nevertheless, data concerning the patient nutritional status and COVID-19 are scarce. The Geriatric Nutritional Risk Index (GNRI) is a general indicator that evaluates the nutritional status of patients, that is, it is a valid and precise risk indicator reflecting the nutritional risk of patients, and has been proven as a prognosis predictor in elderly hospitalized patients. 5 Malnutrition is such reason why these high-risk elderly patients must be monitored. Many of these patients require nourishment, and experience delays in illness recovery, higher mortality, and morbidity. 6 Our previous study reported that clinicians should consider GNRI as a potential predictive factor for COVID-19 prognosis. 7 Moreover, Recinella et al. highlighted that GNRI is an independent predictor of in-hospital mortality in elderly patients with . The association between GNRI and partial pressure of oxygen/fraction of inspired oxygen ratio (PaO 2 /FiO 2 ) is a good prognostic model in these patients. 8 In addition, the most basic element of patient blood management is improving anemia during COVID-19 infection. [9] [10] [11] Owing to general health, changes in lifestyle and diet, elderly individuals may be primarily impacted. Although the exact impact of anemia on COVID-19 patients is not absolutely understood, it is clear the process has a negative effect on COVID-19 patients. Therefore, strategic anemia prevention and management can enhance a patient's tolerance to the virus. Also, GNRI may be invaluable in identifying high-risk patients, for instance, elderly patients with COVID-19. In this study, we analyzed the epidemiological features in patients admitted to our hospital during the outbreak and evaluated whether GNRI could be used as a potential indicator for the prognosis of COVID-19 in elderly patients. were also included in our study. Inclusion criteria were (1) age ≥ 60 and (2) fever or respiratory symptoms, a history of exposure to wildlife in the Wuhan seafood market, a travel history, and/or contact with people from Wuhan in the previous 2 weeks. The incubation period was defined as the time between the source of transmission and symptom onset. This study was approved by the institutional ethics board of the Fifth Hospital of Sun Yat-sen University. This hospital is located in Zhuhai, Guangdong Province, and is a major tertiary teaching hospital responsible for COVID-19 treatment, as assigned by the government. Oral consent was obtained from patients. Epidemiological, laboratory, imaging, treatment, and outcome data were retrieved from electronic medical records. Gathered information contained medical history, symptoms, comorbidities, laboratory indicators, chest computed tomographic scans, and treatment methods. Basic data including age, sex, height, and weight were noted. Blood pressure was measured after the subjects had rested for 10 min. Venous blood was collected 12 h after fasting, and some blood samples were used for routine biochemical tests to determine routine, C-reactive protein (CRP), alanine aminotransferase, aspartate aminotransferase, total serum protein, serum albumin, lactic dehydrogenase, creatine kinase, fasting blood glucose (FBG), creatinine and uric acid (UA) levels. Throat swab samples were collected from patients. After collection, swabs were placed in a collection tube with 150 μl virus preservation solution, and total RNA was extracted within 2 h using a respiratory sample RNA isolation kit (Shanghai ZJ Bio-Tech Co. Ltd.). In brief, 40 μl cell lysate was transferred to a collection tube, followed by vortexing for 10 s. After incubation at room temperature for 10 min, the tube was centrifuged at 1000 rpm for 5 min. The suspension was used for RT-PCR assay of SARS-CoV-2 RNA. Three target viral genes, RdRP, E, and N, were detected and amplified, indicating positivity for SARS-CoV-2. The RT-PCR assay was conducted according to the manufacturer's instructions. All data were analyzed using SPSS 19.0 statistical software (IBM SPSS Statistics for Windows). The Kolmogorov−Smirnov method was used for normality testing. Measured data are expressed as the mean ± standard deviation, with differences examined using independent-sample t tests. Data not normally distributed are expressed as the median and interquartile range (IQR). Differences in variables among groups were analyzed by the Mann−Whitney U Test. The p values were derived from independent-sample t tests or Mann−Whitney U tests. Categorical data were shown as numbers and differences in variables among groups, and were analyzed using the χ 2 test or Fisher probabilities. The study population included 103 hospitalized patients with confirmed COVID-19. Basic clinical characteristics are shown in Table 1 . When compared with younger patients (<60 years, n = 80), elderly patients (n = 23) were significantly older (median age, 65 years [IQR, 60-80] vs. 36.5 years [IQR, 0.83-59]; p < 0.001), and were more likely to have underlying comorbidities, including diabetes (p < 0.05) and hypertension (p < 0.001), with higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) (p < 0.01). When compared with younger patients, elderly patients were more likely to report fatigue and dyspnea. There were, however, no marked differences in exposure history between the two groups (all p > 0.05). We observed several differences in laboratory findings between groups ( Table 2) . Elderly patients had significantly lower lymphocyte percentages, absolute lymphocyte counts, red blood cell counts, hemoglobin levels, and serum albumin values, but they had higher CRP, lactic dehydrogenase, and FBG levels. When compared with younger patients, elderly patients were more likely to present abnormalities on chest computed tomography scans. Organ dysfunctions and treatment of the 103 patients are shown (Table 3) . When compared with younger patients, elderly patients were more likely to have ARDS, have received nutritional support treatment, oxygen inhalation, and intensive care unit (ICU) treatment (p < 0.01). Similarly, elderly patient hospital stay times were significantly longer than younger patients (p < 0.05). When compared with suspected cases, confirmed COVID-19 patients had significantly lower red blood cell counts and hemoglobin levels (p < 0.01). The average GNRI of suspected cases and confirmed patients indicated no nutritional risk. There were, however, no marked differences in GNRI values between groups (Table 4 ). During hospitalization, SBP, DBP, CRP, aspartate aminotransferase, serum albumin, lactic dehydrogenase, creatinine kinase, and FBG had been marked developed over time (all p < 0.05). However, the average GNRI of patients at discharge was not significantly higher than at admission (Table 5 ). Our single-center study of 126 hospitalized patients in Zhuhai, China, included 103 confirmed COVID-19 patients and 23 suspected cases. Our study revealed that elderly patients were more likely to have underlying comorbidities, including diabetes and hypertension, and were more likely to report fatigue and dyspnea. However, there were no significant differences in exposure history between groups. When compared with younger patients, elderly patients were more likely to have ARDS, have received nutritional support, oxygen inhalation, and ICU treatment. Equally, the hospital stay time of elderly patients was longer than younger patients. These data suggested that age and comorbidity may be risk factors for poor outcomes. We observed several differences in laboratory findings between groups ( Table 2) . Elderly patients had significantly lower lymphocyte counts, red blood cell counts, hemoglobin levels, and serum albumin values. They also had higher CRP, lactic dehydrogenase, and FBG levels. When compared with COVID-19 suspected cases, confirmed cases had significantly lower red blood cell counts and hemoglobin levels. For COVID-19 patients, the most basic element of blood management is the improvement of anemia. [9] [10] [11] Because of changes in lifestyle and diet, these findings may increase during the COVID-19 pandemic, and decline purchasing power and income to exacerbate this phenomenon. Possible reasons for this include reduced intake of fresh food such as fruit and vegetables (e.g., reduced vitamin C and folic acid), fish and meat, indoor living, and social distancing. 13, 14 Therefore, there may be effects on the proliferation of red blood progenitor cells, hemoglobin synthesis, and overall physical and mental state. 15 patients. Therefore, strategic anemia prevention and management plans could provide more protection for severe COVID-19 cases. When compared with younger patients, elderly patients were more likely to report chest CT abnormalities, lower lymphocyte percentages, and absolute lymphocyte counts. Pneumonia is a relatively long-lasting disease, often requiring 2-3 months to recover. 17 Elderly people or those with poor health may take longer to produce antibodies, thus experiencing a slower recovery from pneumonia. 18 When compared with younger patients, elderly patients had significantly lower serum albumin levels. The average GNRI of elderly patients indicated no nutritional risk. There were no marked differences in GNRI values between elderly suspected cases and confirmed patients. GNRI is a general indicator that evaluates the nutritional status of patients, that is, it is an effective and simple risk indicator reflecting the nutritional risk of patients, and has been proven as a predictor of hospitalized elderly patient prognosis. 12 GNRI is based on serum albumin and weight loss measurements, Note: p values indicate differences between suspected and confirmed patients. p < 0.05 was considered statistically significant. Abbreviations: BMI, body mass index; CRP, C-reactive protein; DBP, diastolic blood pressure; FBG, fasting blood glucose; GNRI, Geriatric Nutritional Risk Index; IQR, interquartile range; SBP, systolic blood pressure. 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