Influence of nutritional assistance on mortality by COVID-19 in critically ill patients

Abstract

Background & Aims Evidence suggests the existence of an association between the institution of nutritional therapy and clinical outcomes in patients with critical COVID-19. Thus, the aim of this study was to evaluate the influence of nutritional assistance on COVID-19 mortality in patients admitted to intensive care units (ICU). Methods This is a subset of the cohort “Influence of nutritional therapy on clinical prognosis in patients with COVID-19: a multicenter retrospective cohort study”. Clinical and nutrition assistance information (type of assistance, evaluation of anthropometric status, and time of introduction of nutritional therapy) and presence of diabetes, hypertension and previous respiratory disease were collected from electronic medical records. To evaluate the association between the variables of interest and mortality, the hazard ratio was estimated. Results We evaluated 153 critically ill patients ≥18 years old, affected by COVID-19, with a rate of mortality of 77.8%. Among non survivors 58.8% were female, 52.9% aged <65 years, 66.4% had arterial hypertension, 46.2% diabetes mellitus and 81.5% had an early onset of nutritional support. Initiation of nutritional therapy after 48 h (HR: 2.57; 95% CI: 1.57-4.20) and the presence of obesity (HR: 1.55; 95% CI: 1.04-2.31) were associated with higher mortality, even after adjustment for potential confounders. Conclusions Our data suggests that the provision of early nutritional therapy should be prioritized, with greater attention directed to obese patients, and the nutritional assistance can contribute favorably to the clinical evolution and prognosis of critically ill patients with COVID-19.

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

“… 18 When identified as being at high nutrition risk, patients can benefit from nutrition interventions. 42 The systemic inflammation marker NLR can assist in determining this risk because it is associated with the mNUTRIC score, 43 as observed in this study. In agreement with our findings, a previous review and meta‐analysis highlighted the NLR as an imperative marker of prognosis for patients with COVID‐19.…”

“…Likewise, critically ill patients at high nutrition risk should be identified early, as this condition is directly associated with worse clinical outcomes 18 . When identified as being at high nutrition risk, patients can benefit from nutrition interventions 42 . The systemic inflammation marker NLR can assist in determining this risk because it is associated with the mNUTRIC score, 43 as observed in this study.…”

“…It can be used to measure stress, intensity of infection, inflammation, and COVID‐19 outcomes. 42 , 43 …”

“…It can be used to measure stress, intensity of infection, inflammation, and COVID-19 outcomes. 42,43 There is no consensus on cutoff points for the variables NLR and CRP in patients critically ill with COVID-19. Our sample had a median of 12.6 for NLR and 13.8 mg/dl for CRP.…”

Does Route of Full Feeding Affect Outcome among Ventilated Critically Ill COVID-19 Patients: A Prospective Observational Study

“…Despite it being quoted in various guidelines, there is lack of data comparing enteral vs. parenteral feeding among critically ill patients with COVID-19 disease as well as the effect of full feeding (after 5–7 days of ICU stay) on clinical outcomes [ 20 , 21 , 22 , 23 ]. Therefore, the purpose of this study was to describe full feeding practices and highlight their long-term consequences among intubated patients with COVID-19 disease, who were treated within ICU at a reference hospital in Athens.…”