Vaccination and Nutritional Outcomes of Hemodialysis Patients Infected With SARS-CoV-2.

BACKGROUND: Patients on hemodialysis are particularly vulnerable to COVID-19 and may have a reduced response to vaccination because of a decreased immune response. The nutritional status before or during the infection could also impact on the clinical effectiveness of vaccination. OBJECTIVES: We aim to describe the evolution of clinical and nutritional biomarkers of hemodialysis patients infected with SARS-CoV-2 and to assess their association with vaccination status. METHODS: An observational, analytic, longitudinal, retrospective multicenter study was carried out in 82 patients on hemodialysis with SARS-CoV-2 infection. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), anthropometry, and biochemical parameters. The association of the vaccine doses with clinical- and nutritional-related variables was also evaluated. RESULTS: The percentage of vaccinated patients was similar to that of nonvaccinated patients. Before infection, most of the patients were malnourished. They presented lower albumin, creatinine, and urea levels than the well-nourished patients. Significant deterioration of nutritional status after infection was evidenced considering GNRI score, dry weight, and body mass index. Albumin and creatinine also decreased significantly after infection, whereas C-reactive protein increased in the acute phase. Significant inverse correlation was found between the variation of post-pre GNRI scores and basal albumin and C-reactive protein at 7 days. In addition, we observed the opposite trend between albumin at 30 days and basal cholesterol. A negative value in the GNRI variation was associated with bilateral pneumonia, need for hospitalization, and nutritional support. Vaccinated patients presented substantially less bilateral pneumonia and hospitalization. No significant effects were observed between vaccine doses and the variation in nutritional status, although a positive correlation was detected with the albumin at 7 days and C-reactive protein before infection and the number of vaccine doses received. DISCUSSION: COVID-19 is associated with affectations in the nutritional status and biomarkers in hemodialysis patients. In this study, vaccines have shown a protective effect against the clinical consequences of COVID. However, they have shown limitations in preventing the deterioration of nutritional status after infection. The results highlight the importance of promoting the vaccination in these patients as well as incorporating nutritional assessment before, during, and after the infection.

[Assessment of nutritional status on admission and outcome after seven days of hospitalization in a second-level hospital in Madrid]. / Evaluación del estado nutricional al ingreso y evolución tras siete días de hospitalización en un hospital de segundo nivel de Madrid.

INTRODUCTION: Introduction: hospital malnutrition is a highly prevalent problem and continues to be a pending issue today, often unnoticed by health care workers, with the negative clinical impact this entails. Objectives: a) to evaluate nutritional status upon admission; b) to assess the outcome after a week of hospitalization; c) to analyze the relationship between nutritional status and different clinical variables (specialty, age, body weight loss, length of stay, readmissions, and consultations to the endocrinology-nutrition department). Methods: an observational, prospective, analytical, randomized study in 260 patients from medical and surgical services, nutritionally evaluated on admission and after seven days of hospitalization using the SGA and NRS-2002. Results: prevalence at admission according to the SGA was 48 % and according to NRS-2002, 38.5 %. After a week of hospitalization it increased to 72.5 % and 58.8 %, respectively. After seven days, 2-7.8 % of subjects improved their nutritional status, while 16-27.5 % worsened. Malnutrition on admission was associated with longer stay (6 days for non-malnourished vs 8 days for malnourished); with older age (64 years for non-malnourished vs 71 years for malnourished); with medical vs surgical specialties (44-53 % vs 20-32 %); with weight loss (on admission they had lost 2.1 kg on average as compared to usual weight, and 0.9 kg after seven days of hospitalization); and with premature readmission (8-11 % for non-malnourished vs 27 % for malnourished), among others. Conclusions: the study's results offer an overview of hospital malnutrition, showing how patients evolve nutritionally during hospitalization, and which are the crucial moments for action. It is extremely important that health care workers will become aware and take action.

INTRODUCCIÓN: Introducción: la desnutrición hospitalaria es un problema de alta prevalencia y continúa siendo a día de hoy una asignatura pendiente, ya que a menudo pasa desapercibida para el personal sanitario, con las consiguientes repercusiones clínicas negativas que esto conlleva. Objetivos: a) evaluar el estado nutricional al ingreso; b) conocer la evolución tras una semana de hospitalización; c) analizar la relación entre el estado nutricional y distintas variables clínicas (especialidades, edad, pérdida de peso corporal, estancia media, reingresos e interconsultas al servicio de endocrinología-nutrición). Métodos: estudio observacional, prospectivo, analítico y aleatorio de 260 pacientes de servicios médicos y quirúrgicos, evaluados nutricionalmente al ingreso y tras siete días de hospitalización mediante la VGS y la NRS-2002. Resultados: la prevalencia al ingreso según la VGS fue del 48 % y según la NRS-2002 del 38,5 %. Tras una semana de hospitalización, la prevalencia aumentó al 72,5 % y el 58,8 %, respectivamente. Tras siete días, en el 2-7,8 % mejoró el estado nutricional; en cambio, en el 16-27,5 % empeoró. La desnutrición al ingreso se asoció con estancias más prolongadas (6 días los normonutridos frente a 8 días los desnutridos); con una mayor edad (64 años los normonutridos frente a 71 años los desnutridos); con las especialidades médicas más que con las quirúrgicas (44-53 % vs. 20-32 %); con la pérdida de peso (al ingresar habían perdido 2,1 kg de media respecto al peso habitual y 0,9 kg tras siete días de hospitalización); y con los reingresos prematuros (8-11 % los normonutridos frente a 27 % los desnutridos), entre otros. Conclusiones: los resultados hallados nos ofrecen una panorámica de la desnutrición hospitalaria, mostrando cómo evolucionan nutricionalmente los pacientes durante los ingresos y cuáles son los momentos cruciales de actuación. Es sumamente importante que el personal sanitario se conciencie y tome medidas.