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Peer-reviewedCC BY 4.0Nutrients

Nutritional Status at Admission and Clinical Outcomes in Hospitalized Patients with COVID-19: Results from the MODIeCOSe in Italy Study

  • Carola Buscemi1,2
  • Matteo Monami3
  • Cristiana Randazzo1,4
  • Anna Maria Barile1,4
  • Benedetta Ragghianti3
  • Chiara Davoli5
  • Enrico Maria Trecarichi5,6
  • Helen Linda Morrone5
  • Bruno Tassone5
  • Piero Colombrita1,4
  • Carlo Cottone7
  • Maria Elena Greggi7
11 more authors
  • Paolo Sbraccia8,9
  • Valeria Guglielmi8,9
  • Frida Leonetti10
  • Danila Capoccia10
  • Alexis Elias Malavazos11,12
  • Sara Basilico11
  • Ferruccio Santini13
  • Alessandro Antonelli14
  • Nicola Viola13
  • Carlo Torti5,15,16
  • Silvio Buscemi1,4
16 affiliations
  1. 1Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
  2. 2Unit of Internal Medicine, V. Cervello Hospital, 90133 Palermo, Italy
  3. 3Diabetology and Metabolic Disease Unit, Careggi Teaching Hospital and University of Florence, 50134 Florence, Italy
  4. 4Unit of Clinical Nutrition, Obesity and Metabolic Diseases, University Hospital Policlinico “P. Giaccone”, Piazza delle Cliniche 2, 90127 Palermo, Italy
  5. 5Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University—“Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy
  6. 6Department of Life Science, Health, and Health Professions, Link Campus University, 00165 Rome, Italy
  7. 7COVID Internal Medicine Unit, Petralia Sottana Hospital, ASP 6, 90127 Palermo, Italy
  8. 8Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
  9. 9Internal Medicine Unit—Obesity Center, University Hospital Policlinico Tor Vergata, 00133 Rome, Italy
  10. 10Diabetes Unit, Department of Medical-Surgical Sciences and Biotechnology, Santa Maria Goretti Hospital, “La Sapienza” University of Rome, 04100 Latina, Italy
  11. 11Endocrinology Unit, Clinical Nutrition and Cardiometabolic Prevention Service, IRCCS Policlinico San Donato, 20122 Milan, Italy
  12. 12Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy
  13. 13Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
  14. 14Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
  15. 15Department of Healthcare Surveillance and Bioethics, Section of Infectious Diseases, Catholic University of Sacred Heart, 00168 Rome, Italy
  16. 16Infectious Diseases Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, 00133 Rome, Italy
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Abstract

Background/Objectives: Poor nutritional status is common among hospitalized patients and may adversely affect the response to severe acute illness. We investigated the association between nutritional status at hospital admission and clinical outcomes in patients hospitalized with COVID-19 during the first two pandemic waves in Italy. Methods: This retrospective multicenter study included 1187 patients hospitalized with COVID-19 across nine Italian centers participating in the MODIeCOSe in Italia registry. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score, the Prognostic Nutritional Index (PNI), and available anthropometric measures. The primary outcome was a composite of in-hospital death or transfer to an intensive care unit (ICU). Multivariable logistic regression was used to assess the independent association between nutritional status and outcome. Results: Overall, 275 patients (23.2%) experienced the composite adverse outcome. CONUT score was higher in patients with an adverse than in those with a favorable outcome (4.4 ± 2.3 vs. 3.4 ± 1.8; p < 0.001), whereas PNI did not differ significantly. Patients with an adverse outcome also had lower body weight, BMI, waist circumference, and waist-to-height ratio, although anthropometric data were available only in subsets of the cohort. In the main multivariable model adjusted for admission PaO2/FiO2 and relevant clinical covariates, higher CONUT remained independently associated with adverse outcome (OR 1.65, 95% CI 1.12–2.45 per 1-SD increase; p = 0.01). The association was similar in a sensitivity analysis excluding PaO2/FiO2 (OR 1.79, 95% CI 1.28–2.49; p < 0.001). Conclusions: A higher CONUT score at admission was independently associated with an increased risk of in-hospital death or ICU transfer, supporting its prognostic relevance as an immuno-nutritional index in hospitalized patients with COVID-19.

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Cite

BibTeXRIS
BibTeX
@article{buscemi2026nutritional,
  title = {{Nutritional Status at Admission and Clinical Outcomes in Hospitalized Patients with COVID-19: Results from the MODIeCOSe in Italy Study}},
  author = {Carola Buscemi and Matteo Monami and Cristiana Randazzo and Anna Maria Barile and Benedetta Ragghianti and Chiara Davoli and Enrico Maria Trecarichi and Helen Linda Morrone and Bruno Tassone and Piero Colombrita and Carlo Cottone and Maria Elena Greggi and Paolo Sbraccia and Valeria Guglielmi and Frida Leonetti and Danila Capoccia and Alexis Elias Malavazos and Sara Basilico and Ferruccio Santini and Alessandro Antonelli and Nicola Viola and Carlo Torti and Silvio Buscemi},
  journal = {Nutrients},
  year = {2026},
  month = oct,
  doi = {10.3390/nu18203378},
  url = {https://www.mdpi.com/2072-6643/18/20/3378},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Nutritional Status at Admission and Clinical Outcomes in Hospitalized Patients with COVID-19: Results from the MODIeCOSe in Italy Study
AU  - Carola Buscemi
AU  - Matteo Monami
AU  - Cristiana Randazzo
AU  - Anna Maria Barile
AU  - Benedetta Ragghianti
AU  - Chiara Davoli
AU  - Enrico Maria Trecarichi
AU  - Helen Linda Morrone
AU  - Bruno Tassone
AU  - Piero Colombrita
AU  - Carlo Cottone
AU  - Maria Elena Greggi
AU  - Paolo Sbraccia
AU  - Valeria Guglielmi
AU  - Frida Leonetti
AU  - Danila Capoccia
AU  - Alexis Elias Malavazos
AU  - Sara Basilico
AU  - Ferruccio Santini
AU  - Alessandro Antonelli
AU  - Nicola Viola
AU  - Carlo Torti
AU  - Silvio Buscemi
PY  - 2026
DA  - 2026/10/01
JO  - Nutrients
DO  - 10.3390/nu18203378
UR  - https://www.mdpi.com/2072-6643/18/20/3378
AB  - Background/Objectives: Poor nutritional status is common among hospitalized patients and may adversely affect the response to severe acute illness. We investigated the association between nutritional status at hospital admission and clinical outcomes in patients hospitalized with COVID-19 during the first two pandemic waves in Italy. Methods: This retrospective multicenter study included 1187 patients hospitalized with COVID-19 across nine Italian centers participating in the MODIeCOSe in Italia registry. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score, the Prognostic Nutritional Index (PNI), and available anthropometric measures. The primary outcome was a composite of in-hospital death or transfer to an intensive care unit (ICU). Multivariable logistic regression was used to assess the independent association between nutritional status and outcome. Results: Overall, 275 patients (23.2%) experienced the composite adverse outcome. CONUT score was higher in patients with an adverse than in those with a favorable outcome (4.4 ± 2.3 vs. 3.4 ± 1.8; p < 0.001), whereas PNI did not differ significantly. Patients with an adverse outcome also had lower body weight, BMI, waist circumference, and waist-to-height ratio, although anthropometric data were available only in subsets of the cohort. In the main multivariable model adjusted for admission PaO2/FiO2 and relevant clinical covariates, higher CONUT remained independently associated with adverse outcome (OR 1.65, 95% CI 1.12–2.45 per 1-SD increase; p = 0.01). The association was similar in a sensitivity analysis excluding PaO2/FiO2 (OR 1.79, 95% CI 1.28–2.49; p < 0.001). Conclusions: A higher CONUT score at admission was independently associated with an increased risk of in-hospital death or ICU transfer, supporting its prognostic relevance as an immuno-nutritional index in hospitalized patients with COVID-19.
SN  - 2072-6643
ER  -