A correlation of disease severity and outcome with malnutrition status in adults with COVID-19


  • Priyadharshini Krishnaswamy Department of General Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
  • Ashok M. L. Department of General Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India




COVID-19, Malnutrition, Nutrition, CONUT score, Disease severity, Outcome


Background: Coronavirus disease 2019 (COVID-19) pathology increases catabolism and depletes the protein stores, causing malnutrition. However, nutrition assessment in COVID-19 is often overlooked in the current pandemic. The Controlling Nutritional Status (CONUT) score is a validated score to assess nutritional status in hospitalized patients. The objective of the study was to estimate malnutrition among hospitalized adult patients with COVID-19 using the - The Controlling Nutritional Status (CONUT) score and study its effect on the disease severity and outcomes.

Methods: The study was a retrospective study on 146 patients with COVID-19. The history, demographic details were noted and the following parameters were noted at baseline and time of outcome- COVID-19 disease severity, radiological severity, CONUT score, inflammatory markers- serum LDH, CRP, Ferritin, D-Dimer. The outcome parameters- mortality, duration of hospital stay and severity of disease at outcome were measured.

Results: Out of the 146 patients, 84 (57.53%) were male and 62 (42.47%) were female. 97.26% patients had malnutrition at baseline with 42 (28.77%) mild, 70 (47.95%) moderate and 30 (20.55%) severe malnutrition based on CONUT score. The CONUT scores were greater at outcome compared to baseline (p<0.001). Higher grades of malnutrition were associated with greater baseline and outcome disease severity (p<0.001), radiological severity (p<0.001), higher levels of inflammatory markers (p<0.001) and a higher mortality (p<0.001). However, there was no significant difference in duration of hospital stay (p=0.67).

Conclusions: Malnutrition results in worse outcomes and greater mortality in COVID-19. Individual tailored nutritional support in the hospitalized COVID-19 patients, can thus potentially improve outcomes.

Author Biographies

Priyadharshini Krishnaswamy, Department of General Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India


Ashok M. L., Department of General Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India



Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42.

Chidambaram V, Tun NL, Haque WZ, Majella MG, Sivakumar RK, Kumar Aet al. Factors associated with disease severity and mortality among patients with COVID-19: A systematic review and meta-analysis. PloS One. 2020;15(11):e0241541.

Singh AK, Majumdar S, Singh R, Misra A. Role of corticosteroid in the management of COVID-19: A systemic review and a Clinician’s perspective. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020;14(5):971-8.

Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clinical nutrition. 2003;22(3):235-9.

Wei C, Liu Y, Li Y, Zhang Y, Zhong M, Meng X. Evaluation of the nutritional status in patients with COVID-19. Journal of Clinical Biochemistry and Nutrition. 2020;67(2):116-21.

Wright C, Shankar B, Marshall S, Pearcy J, Somani A, Agarwal E. Prevalence of malnutrition risk and poor food intake in older adults in Indian hospitals: a prospective observational nutritionDay study with novel mapping of malnutrition risk to the Malnutrition Screening Tool. Nutrition & Dietetics. 2021;78(2):135-44.

De Ulíbarri JI, González-Madroño A, de Villar NG, González P, González B, Mancha A et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutricion hospitalaria. 2005;20(1):38-45.

Ulíbarri Pérez JI, Fernández G, Salvanés FR, López AM. Nutritional screening; control of clinical undernutrition with analytical parameters. Nutricion hospitalaria. 2014;29(4):797-811.

Aguila EJ, Cua IH. Different barriers to nutritional therapy among critically-ill patients with COVID-19. Clinical Nutrition (Edinburgh, Scotland). 2021;40(2):655.

World Health Organization. Living guidance for clinical management of COVID-19: living guidance, 23 November 2021. World Health Organization. 2021.

Ali AM, Kunugi H. Hypoproteinemia predicts disease severity and mortality in COVID-19: A call for action. Diagnostic Pathology. 2021;16(1):1-3.

Wang R, He M, Yue J, Bai L, Liu D, Huang Z, et al. CONUT score is associated with mortality in patients with COVID-19: a retrospective study in Wuhan. Res Sq. 2021; Available at: https://doi.org/ 10.21203/rs.3.rs-32889/v1. Accessed on 10 December 2021.

Allard L, Ouedraogo E, Molleville J, Bihan H, Giroux-Leprieur B, Sutton A et al. Malnutrition: percentage and association with prognosis in patients hospitalized for coronavirus disease 2019. Nutrients. 2020;12(12):3679.

Song F, Ma H, Wang S, Qin T, Xu Q, Yuan H et al. Nutritional screening based on objective indices at admission predicts in-hospital mortality in patients with COVID-19. Nutrition Journal. 2021;20(1):1-1.

Abate SM, Chekole YA, Estifanos MB, Abate KH, Kabthymer RH. Prevalence and outcomes of malnutrition among hospitalized COVID-19 patients: A systematic review and meta-analysis. Clinical Nutrition ESPEN. 2021;43:174-83.

Ali AM, Kunugi H. Approaches to nutritional screening in patients with Coronavirus Disease 2019 (COVID-19). International Journal of Environmental Research and Public Health. 2021;18(5):2772.

Brugliera L, Spina A, Castellazzi P, Cimino P, Arcuri P, Negro A et al. Nutritional management of COVID-19 patients in a rehabilitation unit. European journal of clinical nutrition. 2020;74(6):860-3.






Original Research Articles