Malnutrition is associated with hyperinflammation and immunosuppression in COVID‐19 patients: A prospective observational study

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Abstract

Background

Coronavirus disease 2019 (COVID‐19) is spreading globally and has caused many deaths. This study investigated, for the first time, COVID‐19 patients’ nutrition status and its effects on their inflammatory and immune responses.

Methods

Forty‐seven COVID‐19 patients were recruited for this prospective study. According to the subjective global assessment at admission, patients were divided into the normal nutrition (NN), risk of malnutrition (RMN), or MN group. Serum cytokines and whole blood T‐cell subpopulations were measured to assess the inflammatory and immune responses in COVID‐19 patients. Analysis of covariance and χ ² tests were used.

Results

On admission, the incidences of MN and the RMN in COVID‐19 patients were 17.0% and 38.3%, respectively. The MN group had a higher proportion with severe/critical COVID‐19 and a longer hospitalization duration than the NN group. Serum interleukin (IL) 6 concentrations were elevated in 97.9% of the patients and were the highest in malnourished patients. The IL‐4 and IL‐10 levels were elevated in 46.8% and 48.9% of the patients, respectively. The proportion of CD8+ T cells was significantly lower in the MN group than in the NN group.

Conclusion

A high proportion of COVID‐19 patients are malnourished or at risk of malnuourishment, especially those with severe disease. MN is associated with hyperinflammation and immunosuppression in COVID‐19 patients, and it may contribute to disease progression.

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Most cited references 38

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Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Chaolin Huang, Yeming Wang, Xingwang Li … (2020)

Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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A Novel Coronavirus from Patients with Pneumonia in China, 2019

Na Zhu, Dingyu Zhang, Wenling Wang … (2020)

Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)

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Author and article information

Contributors

Hong Zhang:

ORCID: https://orcid.org/0000-0002-6236-2475

zhanghong20070703@163.com

Journal

Journal ID (nlm-ta): Nutr Clin Pract

Journal ID (iso-abbrev): Nutr Clin Pract

Journal ID (doi): 10.1002/(ISSN)1941-2452

Journal ID (publisher-id): NCP

Title: Nutrition in Clinical Practice

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 0884-5336

ISSN (Electronic): 1941-2452

Publication date (Electronic): 12 May 2021

Electronic Location Identifier: 10.1002/ncp.10679

Affiliations

[ ¹ ] Department of Gastroenterology First Affiliated Hospital of Anhui Medical University Hefei PR China

[ ² ] Emergency Department First Affiliated Hospital of Anhui Medical University Hefei PR China

[ ³ ] Department of Rheumatology First Affiliated Hospital of Anhui Medical University Hefei PR China

[ ⁴ ] Department of Epidemiology and Health School of Public Health Anhui Medical University Hefei PR China

Author notes

[*] [* ] Correspondence

Hong Zhang, MD, Emergency Department, First Affiliated Hospital of Anhui Medical University. No. 218 Jixi Road, Hefei 230022, P. R. China.

Email: zhanghong20070703@ 123456163.com

[*]

Heng Liu, Liang Zhou, and Hugen Wang contributed equally to this work.

Author information

Hong Zhang https://orcid.org/0000-0002-6236-2475

Article

Publisher ID: NCP10679

DOI: 10.1002/ncp.10679

PMC ID: 8242896

PubMed ID: 33978988

SO-VID: 8b2191a8-9d76-4090-af16-2ddf99f84610

License:

This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

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Page count

Figures: 1, Tables: 3, Pages: 9, Words: 5844

Funding

Funded by: Anhui Medical University , open-funder-registry 10.13039/501100002947;

Award ID: YJSK202012

Funded by: Health Commission of AnHui Province

Award ID: 2020WR02003

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details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.2 mode:remove_FC converted:30.06.2021

Keywords: coronavirus disease 2019,cytokines,immunosuppression,inflammation,malnutrition,nutrition status

Data availability:

Keywords: coronavirus disease 2019, cytokines, immunosuppression, inflammation, malnutrition, nutrition status

Malnutrition is associated with hyperinflammation and immunosuppression in COVID‐19 patients: A prospective observational study

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Novel Coronavirus Disease COVID-19

Most cited references 38

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Clinical Characteristics of Coronavirus Disease 2019 in China

A Novel Coronavirus from Patients with Pneumonia in China, 2019

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