Association of nitrogen balance trajectories with clinical outcomes in critically ill COVID-19 patients: A retrospective cohort study

Dupuis, Claire; Bret, Alexandre; Janer, Alexandra; Guido, Olivia; Bouzgarrou, Radhia; Dopeux, Loïc; Hernandez, Gilles; Mascle, Olivier; Calvet, Laure; Thouy, François; Couhault, Pierre; Kinda, Francis; Laurichesse, Guillaume; Bonnet, Benjamin; Adda, Mireille; Boirie‌, Yves; Souweine, Bertrand

doi:10.1016/j.clnu.2022.08.023

Cited by 4 publications

(12 citation statements)

References 51 publications

(56 reference statements)

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“…Overall, all three studies showed that patients remained in negative balances in the first week of admission, in which NBAL ranged from −12.1 to −0.7 g/kg, 21,22 and urinary nitrogen losses were 18 ± 11 g/day. 16 In the acute phase of illness (≤7 days from ICU admission), patients who achieved nitrogen equilibrium received more protein than those with a negative NBAL (1.2 ± 0.4 vs 0.8 ± 0.8 g/kg/day, P = 0.046).…”

Section: Proteinmentioning

confidence: 91%

“…15,[18][19][20] Figure 1 shows that REE generally increased with time. The weighted mean REE (kilocalories per kilogram of BW) of nonobese patients in week 1, week 2, week 3, and week 4 were approximately 21 (range: 18-25), 26 (range: 23-29), 32 (range: [19][20][21][22][23][24][25][26][27][28][29][30][31], and 29 (range: 19-29), respectively. 15,[18][19][20] The weighted mean REE (kilocalories per kilogram of adj-BW) of patients with obesity in week 1, week 2, week 3, and week 4 were approximately 19 (range: 18-20), 27 (range: 26-27), 30 (range: 27-33-25), and 29 kcal/kg, respectively.…”

Section: Energymentioning

confidence: 99%

“…Most patients were male (64%-67%) and with obesity (45%-57.1%). Two studies 21,22 estimated nitrogen balance (NBAL) (grams per day) using urinary nitrogen losses and defined nitrogen equilibrium as NBAL −4 g/day to +4 g/day, with a positive NBAL defined as more than 4 g/day and a negative NBAL defined as less than −4 g/day. This was after considering stool, integumentary, and other insensible nitrogen losses.…”

Section: Proteinmentioning

confidence: 99%

“…16 In the acute phase of illness (≤7 days from ICU admission), patients who achieved nitrogen equilibrium received more protein than those with a negative NBAL (1.2 ± 0.4 vs 0.8 ± 0.8 g/kg/day, P = 0.046). 21 However, Dupuis et al 22 showed that their patients required even higher protein intakes, ranging from 1.64 to 2.1 g/kg/day, to achieve nitrogen equilibrium by day 7.…”

Section: Proteinmentioning

confidence: 99%

“…33 The three observational studies presented above showed that critically ill patients with SARS-CoV-2 remained in prolonged catabolic states, with negative nitrogen balances, up to 1 week after admission. During the second week of ICU admission, the results were inconclusive as Dupuis et al 22 found that patients improved from their catabolic state, whereas Lakenmen et al 16 found that patients were worse off compared with their first week of admission. However, we must note that the former fed their patients more aggressively, with at least 20% higher protein targets than the latter, which may explain this observation.…”

Section: Protein Requirementsmentioning

confidence: 99%

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Macronutrient and micronutrient requirements and therapeutic effects in critically ill patients with SARS‐CoV‐2: A narrative review

Huang

Lew

2023

Nut in Clin Prac

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Background: COVID-19 can lead to critical illness and induce hypermetabolism, protein catabolism, and inflammation. These pathological processes may alter energy and protein requirements, and certain micronutrients may attenuate the associated detriments. This narrative review summarizes the macronutrient and micronutrient requirements and therapeutic effects in critically ill patients with SARS-CoV-2.Methods: We searched four databases for randomized controlled trials (RCTs) and studies that measured macronutrient and micronutrient requirements, published from February 2020 to September 2022.Results: Ten articles reported on energy and protein requirements, and five articles reported the therapeutic effects of ω-3 (n = 1), group B vitamins (n = 1), and vitamin C (n = 3). Patients' resting energy expenditure gradually increased with time, measuring approximately 20 kcal/kg body weight (BW), 25 kcal/kg BW, and 30 kcal/kg BW for the first, second, and third week onwards, respectively. Patients remained in negative nitrogen balances in the first week, and a protein intake of ≥1.5 g/kg BW may be necessary to achieve nitrogen equilibrium. Preliminary evidence suggests that ω-3 fatty acids may protect against renal and respiratory impairments. The therapeutic effects of group B vitamins and vitamin C cannot be ascertained, although intravenous vitamin C appears promising in reducing mortality and inflammation. Conclusion:There are no RCTs to guide the optimal dose of energy and protein in critically ill patients with SARS-CoV-2. Additional larger-scale, well-designed RCTs are needed to elucidate the therapeutic effects of ω-3, group B vitamins, and vitamin C.

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Section: Proteinmentioning

confidence: 91%

Section: Energymentioning

confidence: 99%

Section: Proteinmentioning

confidence: 99%

Section: Proteinmentioning

confidence: 99%

Section: Protein Requirementsmentioning

confidence: 99%

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Macronutrient and micronutrient requirements and therapeutic effects in critically ill patients with SARS‐CoV‐2: A narrative review

Huang

Lew

2023

Nut in Clin Prac

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High protein intake and nitrogen balance in patients receiving venovenous extracorporeal membrane oxygenation: A descriptive cohort study

Pelekhaty,

Peiffer,

Leibowitz

et al. 2024

J Parenter Enteral Nutr

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BackgroundThis retrospective cohort study sought to describe the ability of high protein regimens to achieve nitrogen equilibrium in patients on venovenous extracorporeal membrane oxygenation (VV‐ECMO)MethodsPatients ≥18 years with a documented nitrogen balance study (NB) on VV‐ECMO between February 2018 and December 2021 were included. NB with incomplete 24‐hour urine collections or changes in blood urea nitrogen ≥10 mg/dL were excluded. Data were summarized, correlation between first NB and potentially contributing variables was assessed with Kendall's Tau. Sub‐analysis described findings after stratifying for weight class (obese vs non‐obese) and duration of VV ECMO at the time of NB.ResultsA total of 68 NB in 30 patients were included; 47% of the cohort had obesity. The number of NB per patient was 2.2 ± 1.1, which were completed on a median of 31.5 (interquartile range: 16, 53.8) days on ECMO. Nitrogen equilibrium or positive balance was achieved in 72% of studies despite elevated nitrogen excretion. Patients received 87.9 ± 16.8% of prescribed protein on NB days for average intakes of 2.4 ± 0.4 g/kg actual weight/day and 2.4 ± 0.5 g/kg ideal weight/day in patients without and with obesity. Median NB in non‐obese was −1.46 (−8.96, 2.98) g/day, and −0.21 (−10.58, 4.04) g/day in patients with obesity. A difference in median NB after stratification for timing was observed (p=0.029).ConclusionNitrogen equilibrium can be achieved with high protein intake in adults on VV‐ECMO. NB monitoring is one tool to individualize protein prescriptions throughout the course of VV ECMO.This article is protected by copyright. All rights reserved.

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Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China

Guan,

Chen,

2024

Journal of Intensive Medicine

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Association of nitrogen balance trajectories with clinical outcomes in critically ill COVID-19 patients: A retrospective cohort study

Cited by 4 publications

References 51 publications

Macronutrient and micronutrient requirements and therapeutic effects in critically ill patients with SARS‐CoV‐2: A narrative review

Macronutrient and micronutrient requirements and therapeutic effects in critically ill patients with SARS‐CoV‐2: A narrative review

High protein intake and nitrogen balance in patients receiving venovenous extracorporeal membrane oxygenation: A descriptive cohort study

Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China

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