Prognostic Significance Of The CONUT Score In Patients With Coronavirus Disease 2019 And Clinical Characteristics Of Elderly Patients With COVID-19

BackgroundA novel coronavirus,named 2019-nCoV,was first found in December 2019 in China.It is rapidly transmitted,which causing an outbreak of pneumonia(COVID-19)in the following month,and has been a global health threat.Fever,dry cough and fatigue are the main initial clinical manifestations.Although most patients present mild symptoms and quickly recover,the disease can cause severe respiratory disease,multiple organ dysfunction and even death.Preventing further spread of the epidemic,correct diagnosis and effective treatment of critical patients,are the key and difficult problems in the response in terms of epidemic prevention.In recent years,more and more attention has been paid to the relationship between malnutrition and prognosis.As the nutritional status of the host exerts a crucial role in the defense against infection,individuals with nutritional deficiency are more susceptible to pneumonia and other infectious diseases,which can result harmful consequences such as prolonged hospital stay and increased complications.Nutritional risk screening tools such as NRS2002 and MNA-SF are not easy to operate and are limited by the level of operators.Therefore,it is crucial to find a simple and effective nutritional screening tool to assess the nutritional status in patients with COVID-19.The controlling nutritional status(CONUT)score is a simple and practical comprehensive index to evaluate the nutritional status of inpatients.The CONUT score has been applied in hypertension,heart failure and many malignancies for its prognostic value.However,the relationship between the CONUT score and the prognosis in patients with COVID-19 remains unknown.Purpose1.To analyze the nutritional status of patients with severe COVID-19 based on the CONUT score.2.To compare the clinical characteristics of patients in different nutritional status groups.3.To evaluate the prognostic value of the CONUT score in severe COVID-19 patients.Materials and MethodsWe recruited 348 severe patients with confirmed COVID-19.These patients were hospitalized in the Renmin Hospital of Wuhan University from January 3,2020 to March 11,2020.Information of enrolled patients was obtained through the electronic medical record system,including epidemiological,clinical and laboratory characteristics,treatment options and outcomes.The CONUT score was calculated from lymphocyte counts,TC and serum albumin levels on admission.The patients were grouped according to the CONUT score.All data were statistically analyzed using SPSS 25.0.Results1.Among 348 patients,the median age was 66 years,including 47.7%female and 52.3%male.When compared to the other two groups,patients in moderate-severe group were older and more male,as well as the counts of white blood cell and neutrophil and the serum levels of C-reactive protein(CRP),aspartate aminotransferase(AST),lactate dehydrogenase(LDH),creatine kinase-myocardial isoenzyme(CK-MB)were higher(P<0.05).The proportion of acute myocardial injury in moderate-severe malnutrition group was much higher.In addition,the mortality among the three groups showed an increasing trend(P<0.05).2.After excluding 17 inpatients,331 patients were divided into survival and non-survival groups,and the CONUT score of non-survival group was significantly higher(P<0.001).In subgroup analysis based on the counts of lymphocytes(≥0.8×109/L),we found that non-survivors always had higher CONUT score regardless of the counts of lymphocyte(P<0.05).3.According to multivariate logistic regression analysis,it was showed that malnutrition,advanced age,dyspnea,coronary heart disease,elevated serum CRP and LDH levels,and acute cardiac injury were independent risk factors of death in patients with COVID-19(P<0.05).The area under ROC curve was 0.798(95%CI:0.747-0.850,P<0.001),and the CONUT score=4.5 had a maximizing the Youden index,with a sensitivity and specificity of 74.1%and 72.0%,respectively.Conclusion1.Based on CONUT score,malnutrition is often found in severe COVID-19 patients.2.The CONUT score is significantly associated with the prognosis of patients with severe COVID-19.3.As a convenient and effective method,the CONUT score can independently predict the prognosis of severe COVID-19 patients.BackgroundCOVID-19 caused by a novel coronavirus(SARS-CoV-2)has spread rapidly during the past several months.People of all ages are susceptible to it.However,it is worth noting that older people have higher morbidity and severity than younger individuals,and even the majority of deaths caused by COVID-19 are elderly people.It is estimated that the mortality was 1.4%in the patients less than 60 years old while increased to 4.5%in older individuals over 60 years old and 14.8%in patients aged 80 or older.The number of the aged has dramatically augmented globally and subsequently,the frequency of age-associated diseases also increased significantly.Considering the complexity of elderly patients with COVID-19,treatment has always been a huge challenge.Purpose1.To compare the characteristics and manifestations of patients among different age.2.To assess the lung and extrapulmonary organ damage in elderly patients with COVID-19.3.To explore the possible risk factors influencing the prognosis of elderly patients.MethodsIn this retrospective study,566 patients with COVID-19 hospitalized from January 3,2020 to March 16,2020 at Renmin Hospital of Wuhan University were enrolled.According to the age,patients were divided into three age groups.Epidemiological characteristics,laboratory findings,complications,treatment options and outcomes of enrolled patients were obtained from the electronic medical records.In order to further understand the disease characteristics of the elderly,they were further divided into the younger old(60 to 74 years)and the oldest-old(≥75 years)groups.Data were analyzed using IBM SPSS Statistics for Windows version 25.0.Prognostic factors of older patients were identified by univariate and multivariate logistic regression.The differences were considered to be statistically significant at P<0.05.Results1.Of 566 patients,the median age was 61.5 years and 47.2%of patients were male.Compared with the other two age groups,the older group had a higher incidence of any coexisting diseases(P<0.05).Older patients exhibited higher counts of neutrophils and serum levels of CRP,AST,LDH,blood glucose,urea nitrogen and creatinine as well as lower numbers of lymphocytes,hemoglobin and platelet(P<0.05).A higher rate of acute cardiac injury was found in the older group when compared with those in younger and middle-aged groups(P<0.05).There was no difference of acute liver injury,acute kidney injury and skeletal muscle injury among the three groups.2.Among the 307 older patients,there were 216(70.4%)younger old patients and 91(29.6%)oldest-old patients.Compared with the younger old,oldest-old patients had higher counts of neutrophils and serum levels of CRP,AST,urea nitrogen,creatinine,LDH,CK-MB and cTnI,while lower counts of lymphocytes and platelet and serum albumin levels(P<0.05).Oldest-old patients exhibited higher incidence of extrapulmonary organ damage,including acute cardiac injury,heart failure,skeletal muscle injury and kidney injury than those in younger old patients(P<0.05).Importantly,the mortality of the oldest-old patients was much higher than younger old patients(P<0.001).3.Multivariate logistic regression analysis showed that age,ARDS,acute cardiac injury,heart failure,skeletal muscle injury and lymphopenia were all independent risk factors associated with death.Disappointedly,glucocorticoids were associated with an increased mortality in older patients with COVID-19.Conclusion1.Older patients,especially the oldest-old patients are more likely to exhibit significant pulmonary and extrapulmonary organ damage and a higher mortality.2.Multiple complications such as ARDS,heart and skeletal muscle injury are independent risk factors of death in elderly patients with COVID-19.