Acute Hypertriglyceridemia in Patients with COVID-19 Receiving Parenteral Nutrition

Abstract

Hypertriglyceridemia is a metabolic complication associated with parenteral nutrition (PN). It is unknown if patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 are more at risk. Our aim was to describe the incidence, risk factors and clinical impact of hypertriglyceridemia in critically ill patients with ARDS-COVID-19 receiving PN. We designed a cohort study of patients with ARDS-COVID-19 infection that required admission to critical care units and nutritional support with PN. Individual PN prescriptions for macronutrients and insulin were provided. Lipid emulsion contained fish oil (SMOFlipid® or Lipoplus®). Hypertriglyceridemia was defined as plasma levels above 400 mg/dL. Eighty-seven patients, 66.6% men, 60.1 ± 10.8 years old, BMI 29.1 ± 5.6 kg/m2, 71% of whom received lopinavir/ritonavir, 56% received Propofol and 55% received Tocilizumab were included. The incidence of hypertriglyceridemia was 37 × 100 patient-days with PN. This complication was more frequent in obese patients (OR 3.34; 95% CI, 2.35–4.33) and in those treated with lopinavir/ritonavir (OR 4.98; 95% CI, 3.60–6.29) or Propofol (OR 2.45; 95% CI, 1.55–3.35). Total mortality was 33.3%, similar between the type of lipid emulsion (p = 0.478). On average, patients with hypertriglyceridemia had a longer requirement of PN compared to the group without elevated triglycerides (TG), probably because of their longer survival (p = 0.001). TG higher than 400 mg/dL was not a protective factor for mortality (OR 0.31; 95% CI, 0.01–1.30). In conclusion, the incidence of hypertriglyceridemia was 37 × 100 patient-days with PN. The risk of this complication is associated with obesity and the use of lopinavir/ritonavir or Propofol.

Pseudohyponatremia: Mechanism, Diagnosis, Clinical Associations and Management

“…Two methods, field mass spectrometry and enzymatic determination, are worth exploring: field mass spectrometry is a promising recent technology for measuring electrolyte concentrations in biological fluids [ 164 , 165 ]; its measurement of the sodium concentration based on specific enzyme (β-galactosidase) activation by sodium ions has been applied in certain clinical conditions, e.g., isolation laboratories for emerging infectious diseases [ 26 , 166 , 167 ]. The Supplementary Material Section S1 provides further information about conditions causing hyperlipidemia [ 153 , 154 , 168 , 169 , 170 , 171 , 172 , 173 , 174 , 175 , 176 , 177 , 178 , 179 , 180 , 181 , 182 , 183 , 184 , 185 , 186 , 187 , 188 , 189 , 190 , 191 , 192 , 193 , 194 , 195 , 196 , 197 ].…”

“…The following supporting information can be downloaded at: , Section S1-Clinical conditions causing increased serum solid content [ 168 , 169 , 170 , 171 , 172 , 173 , 174 , 175 , 176 , 177 , 178 , 179 , 180 , 181 , 182 , 183 , 184 , 185 , 186 , 187 , 188 , 189 , 190 , 191 , 192 , 193 , 194 , 195 , 196 , 197 ].…”

Hyperlipidemia, COVID-19 and acute pancreatitis: A tale of three entities

“…Thirty-four papers were reviewed after screening, which reported the incidence of hyperlipidemia in COVID-19 patients ( Table 2 ). 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 The incidence of hyperlipidemia ranged from 0.30% to 81.82% in COVID-19 patients among different studies. Potential reasons for the variations could be: 1) Regional factors led to the difference in baseline lipids levels; 2) The definition of hyperlipidemia varied in different studies.…”

Nutrition priorities in obese critically ill patients

“…A recent meta-analysis of 18 trials that compared enteral nutrition with parenteral nutrition regardless of timing found no difference in mortality but enteral nutrition was associated with fewer infectious complications and shorter ICU length of stay [74]. Obese patients might be at higher risk of hypertriglyceridemia with parenteral nutrition [75]. Nevertheless, parenteral nutrition could be considered in obese critically ill patients after the first 1 week in the ICU if nutritional targets are not met, particularly in patients who are malnourished.…”