2025, Ilkowski, Jan, Guzik, Przemysław, Kaluźniak-Szymanowska, Aleksandra, Rzymski, Piotr, Chudek, Jerzy, Wieczorowska-Tobis, Katarzyna

Background: Malnutrition is an often-overlooked yet potentially crucial factor influencing COVID-19 outcomes. Poor nutritional status weakens immune function, increases infection susceptibility, and worsens prognoses in hospitalized patients. However, its specific role in COVID-19 mortality remains insufficiently characterized. The aim of the study was to assess the impact of malnutrition, as determined by the Nutritional Risk Score (NRS-2002), on in-hospital mortality. Methods: This retrospective, single-center study analyzed 222 patients hospitalized with COVID-19 during the Delta variant predominance. Thirty-one patients died during hospitalization. Malnutrition (NRS ≥ 3) emerged as a strong predictor of in-hospital mortality in univariate Cox proportional hazard models, both before and after adjustment for potential confounders. Adjusted analyses used 10 different sets of three out of five mortality-related variables. Results: Hazard ratios for malnutrition ranged from 3.19 to 5.88 (p < 0.01 for all models), highlighting its substantial impact on mortality risk. The high Nagelkerke’s R2 values (0.66–0.77) indicate that the models explained a significant proportion of mortality variance. Nutritional status plays a critical role in COVID-19 survival among hospitalized patients. Conclusions: Given its simplicity and effectiveness, integrating the NRS-2002 into routine clinical assessments may help identify high-risk patients early. Future research should explore whether early nutritional interventions can mitigate the mortality risks associated with malnutrition in severe COVID-19 cases or patients with other infectious diseases or acute inflammation.

2025, Ilkowski, Jan, Wieczorowska-Tobis, Katarzyna, Guzik, Przemyslaw

Activities of Daily Living (ADL) are fundamental tasks for individuals to manage their basic needs. Our study aims to examine ADL at admission (adADL) and the Pre-COVID-19 to Admission ADL Difference (ADL-change) as potential predictors of in-hospital mortality. This is a retrospective analysis of clinical data (including the Katz index for ADL) from 141 older patients aged at least 65 years hospitalized in a COVID-19-dedicated unit (not requiring ICU) from September 2021 until January 2022 in Poznań, Poland. Thirty patients (21.3% of all) died during hospitalization. Non-survivors were older than survivors, exhibited lower oxygen saturation, more severe inflammation, higher D-dimer concentrations, and were more commonly prescribed antibiotics. The AUC for in-hospital mortality was for adADL: 0.7417 (95% CI: 0.6478–0.8357; p < 0.0001) and for ADL-change: 0.6869 (95% CI: 0.579–0.7928; p = 0.0018). The corresponding cut-offs were 0 for adADL and 3 for ADL-change. Cox proportional hazard models yielded hazard ratios of 3.57 (95% CI 1.57–8.10; p = 0.0024) for adADL and 3.78 (95% CI 1.49–9.54; p = 0.005) for ADL-change. ADL assessment offers valuable insights into in-hospital mortality among older COVID-19 patients. Monitoring ADL in these patients indicates high-risk individuals for in-hospital death. Integrating ADL into routine clinical practice might enhance care for older patients.