High neutrophil-to-lymphocyte ratio at intensive care unit admission is associated with nutrition risk in patients with COVID-19

Background Inflammation plays a crucial role in nutrition status and can be useful in early nutrition risk screening of patients during the coronavirus disease 2019 (COVID-19) pandemic. Thus, this study aimed to assess the association between systemic inflammatory markers and nutrition risk tools in intensive care unit (ICU) patients with COVID-19. Methods Patients with confirmed COVID-19 and ICU admission were enrolled in a retrospective, observational, cross-sectional study. The medians of C-reactive protein (CRP; >= 13.8 mg/dl) and the neutrophil-to-lymphocyte ratio (NLR; >= 12.6) upon admission were used to dichotomize patients. Results Of the 73 patients, 63% were men; the average age was 56 years, and the median length of hospital stay was 10 (25th: 4; 75th: 17) days. When nutrition risk screening tools were used, 85% were at risk according to Nutritional Risk Screening (>= 3 points), whereas 42% had high risk according to the Modified Nutrition Risk in the Critically Ill (mNUTRIC; >= 5 points), and 57% were moderately or severely malnourished according to the Subjective Global Assessment (B or C). Mortality was higher in the group with NLR >= 12.6 than in the group with NLR <12.6, with no difference between CRP groups. A significant association was found only between NLR and mNUTRIC, even when adjusted by sex, age, and body mass index (odds ratio, 1.36; 95% CI, 1.06-1.76; P = 0.016), but not between CRP and nutrition risk. Conclusion Although the inflammatory marker CRP is the most used in hospital clinical practice, we found that only NLR was associated with nutrition risk (NUTRIC score).