Nutritional and metabolic support in critically-ill patients with COVID-19 disease: A multicenter cohort study

Abstract

Summary: Background & Aims: Patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) develop an acute inflammatory response that leads to a catabolic state. This increases the nutritional requirements and, consequently, the risk of malnutrition and related complications. Severe infection also leads to increased length of hospital stay, patient deconditioning, and mortality. Therefore, this study aims to establish if existing nutritional parameters should be considered in the multidisciplinary treatment of patients severely infected with SARS-COV-2. Methods: A multicenter cross-sectional observational study was done. Adult patients with severe SARS-COV-2 infection who required management in the intensive care unit (ICU) needing invasive ventilatory support were included. A descriptive analysis was performed, followed by a bivariate data analysis. The primary outcomes were mortality and nutrition intolerance. Results: One hundred ninety-four patients with severe SARS-COV-2 infection who required invasive mechanical ventilation were included. The overall mortality was 52.57%, and intolerance to nutrition was present in 24.74% of the patients. Mortality was higher in patients with lower caloric intake (P<0.001), energy deficit (P<0.001), higher APACHE score (P=0.026), and higher SOFA score at ICU admission (P=0.012). Conclusion: Achieving nutritional optimization for patients with severe SARS-CoV-2 infection is challenging. Nevertheless, interventions such as timely nutritional support and early recognition of caloric deficit and nutritional intolerance positively impact mortality, length of stay, and deconditioning for these individuals.

Keywords

• SARS-COV-2
• COVID-19
• Invasive mechanical ventilation
• Nutrition
• Cohort