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

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

“…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).…”

“…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.…”

“…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.…”

“…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.…”

“…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.…”