Nutritional parameters and outcomes in patients admitted to intensive care with COVID-19: a retrospective single-centre service evaluation

Abstract

BackgroundCOVID-19 is an inflammatory syndrome caused by novel coronavirus SARS-CoV-2. Symptoms range from mild infection to severe acute respiratory distress syndrome (ARDS) requiring ventilation and intensive care. At the time of data collection, UK cases were around 300 000 with a fatality rate of 13% necessitating over 10 000 critical care admissions; now there have been over 4 million cases. Nutrition is important to immune function and influences metabolic risk factors such as obesity and glycaemic control, as well as recovery from acute illnesses. Poor nutritional status is associated with worse outcomes in ARDS and viral infections, yet limited research has assessed pre-morbid nutritional status and outcomes in patients critically unwell with COVID-19.ObjectivesInvestigate the effect of body mass index (BMI), glycaemic control and vitamin D status on outcomes in adult patients with COVID-19 admitted to an intensive care unit (ICU).MethodsRetrospective review of all patients admitted to a central London ICU between March and May 2020 with confirmed COVID-19. Electronic patient records data were analysed for patient demographics; comorbidities; admission BMI; and serum vitamin D, zinc, selenium and haemoglobin A1c (HbA1c) concentrations. Serum vitamin D and HbA1c were measured on admission, or within 1 month of admission to ICU. Primary outcome of interest was mortality. Secondary outcomes included time intubated, ICU stay duration and ICU-related morbidity.ResultsSeventy-two patients; 54 (75%) men, mean age 57.1 (±9.8) years, were included. Overall, mortality was 24 (33%). No significant association with mortality was observed across BMI categories. In the survival arm admission, HbA1c (mmol/mol) was lower, 50.2 vs 60.8, but this was not statistically significant. Vitamin D status did not significantly associate with mortality (p=0.131). However, 32% of patients with low vitamin D (<25 IU/L) died, compared with 13% of patients with vitamin D levels >26 IU/L. Serum zinc and selenium, and vitamin B12 and folate levels were measured in 46% and 26% of patients, respectively.Discussion/conclusionIncreased adiposity and deranged glucose homeostasis may potentially increase risk of COVID-19 infection and severity, possibly relating to impaired lung and metabolic function, increased proinflammatory and prothrombotic mechanisms. Vitamin D deficiency may also associate with poorer outcomes and mortality, supporting a possible role of vitamin D in immune function specific to pulmonary inflammation and COVID-19 pathophysiology. There are plausible associations between raised BMI, glycaemic control, vitamin D status and poor prognosis, as seen in wider studies; however, in this service evaluation audit during the first wave of the pandemic in the UK, with a limited data set available for this analysis, the associations did not reach statistical significance. Further research is needed into specific nutritional markers influencing critical care admissions with COVID-19.

Nutritional and Morphofunctional Assessment of Post-ICU Patients with COVID-19 at Hospital Discharge: NutriEcoMuscle Study

“…Moreover, nearly two-thirds exhibited low handgrip strength, while 27.1% of the patients were at higher risk of falling, according to the TUG test. The high degree of physical dysfunction was consistent with the results of other similar studies [ 20 , 21 , 22 ]. Several factors may explain the results, including sarcopenic obesity, inflammatory mediators, and insulin resistance [ 42 ].…”

“…The study data show that the COVID-19 patients admitted to intensive care in this study had a mean age of 58.8 years and were mostly male, which is consistent with other studies [ 20 , 21 , 22 ]. Overweight and obesity were highly prevalent in our cohort, as reported by other authors as well [ 29 ].…”

“…At hospital discharge, all post-ICU COVID patients exhibited varying degrees of malnutrition with substantial and sudden weight loss during their hospital stay. Previous studies have also reported a significant prevalence of malnutrition [ 20 , 21 , 22 ]. The causes of this weight loss and malnutrition are multifactorial.…”

Could Selenium Supplementation Prevent COVID-19? A Comprehensive Review of Available Studies

“…One study only looked retrospectively at the mean serum selenium level of 33 COVID-19 patients (out of 72 with mean age 57.1 ± 9.8 years) at Intensive Care Unit (ICU) admission (West London, UK, March–May 2020), finding it to be within the normal range despite a 33% mortality [ 32 ]. Voelkle and coworkers concluded that, even though selenium deficiency was found in 51% of 57 COVID-19 cases consecutively admitted between 17 March 2020 and 30 April 2020 at the Cantonal Hospital Aarau (Switzerland), “no association between low selenium levels and adverse clinical outcomes was found” [ 33 ].…”

Rationale and Experience of Vitamin B12 Usage in Complex Therapy of COVID-19 and Post-COVID Syndrome

“…Публикация T. Eden и соавт. свидетельствует, что гипергомоцистеинемия (определенная в статье как уровень более 15,5 мкмоль/л) в значительном числе случаев имела положительную корреляцию со степенью поражения легких, оцененной по компьютерной томограмме у 273 пациентов с COVID-19, что говорит о его значимости при тяжелом течении COVID-19 [32].…”