Can COVID-19 be a risk for cachexia for patients during intensive care? Narrative review and nutritional recommendations

Virgens, Isabel Pinto Amorim das; Santana, Natália M; Lima, Severina Carla Vieira Cunha; Fayh, Ana Paula Trussardi

doi:10.1017/s0007114520004420

Cited by 29 publications

(29 citation statements)

References 88 publications

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“…Yet the proportion of severe malnutrition, predominant at ICU discharge, decreased from M1 at the benefit of moderate malnutrition. Although the relatively small sample of patients precludes to draw definite conclusions, determinants of persistent malnutrition seemed to lie within the length of ICU stay and of organ support rather than related to preadmission characteristics or nutritional support during and after the ICU stay, as hypothesized by Virgens et al [17] and others [16]. Interestingly, only 32% of patients in whom undernutrition persisted at M3 had benefited from a nutritional support, suggesting that malnutrition was either underrecognized or undertreated in this population.…”

Section: Discussionmentioning

confidence: 79%

Evolution of the nutritional status of COVID-19 critically-ill patients: A prospective observational study from ICU admission to three months after ICU discharge

et al. 2022

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Background and aims Malnutrition following intensive care unit (ICU) stay is frequent and could be especially prominent in critically ill Coronavirus Disease 2019 (COVID-19) patients as they present prolonged inflammatory state and long length stay. We aimed to determine the prevalence of malnutrition in critically ill COVID-19 patients both at the acute and recovery phases of infection. Methods We conducted a prospective observational study including critically ill COVID-19 patients requiring invasive mechanical ventilation discharged alive from a medical ICU of a university hospital. We collected demographic, anthropometric and ICU stay data (SAPS2, recourse to organ support and daily energy intake). Nutritional status and nutritional support were collected at one month after ICU discharge (M1) by phone interview and at 3 months after ICU discharge (M3) during a specialized and dedicated consultation conducted by a dietitian. Malnutrition diagnosis was based on weight loss and body mass index (BMI) criteria following the Global Leadership Initiative on Malnutrition. Primary outcome was the prevalence of malnutrition at M3 and secondary outcomes were the evolution of nutritional status from ICU admission to M3 and factors associated with malnutrition at M3. Results From march 13 th to may 15 th , 2020, 38 patients were discharged alive from the ICU, median [IQR] age 66 [59-72] years, BMI 27.8 [25.5-30.7] kg/m 2 and SAPS2 47 [35-55]. Thirty-three (86%) patients were followed up to M3. Prevalence of malnutrition increased during the ICU stay, from 18% at ICU admission to 79% at ICU discharge and then decreased to 71% at M1 and 53% at M3. Severe malnutrition prevailed at ICU discharge with a prevalence of 55% decreasing 32% at M3. At M3, the only factors associated with malnutrition in univariate analysis were the length of invasive mechanical ventilation and length of ICU stay (25 [16-39] vs. 11 [9-12] days, P=0.006 and 28 [21-42] vs. 15 [11-17] days, P=0.010, respectively), while no ICU preadmission and admission factors, nor energy and protein intakes distinguished the two groups. Only 32% of undernourished patients at M3 had benefited from a nutritional support. Conclusion Malnutrition is frequent, protracted and probably underrecognized among critically ill Covid-19 patients requiring invasive mechanical ventilation with more than half patients still being undernourished three months after ICU discharge. A particular attention should be paid to the nutritional status of these patients not only during their ICU stay but also following ICU discharge.

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Section: Discussionmentioning

confidence: 79%

Evolution of the nutritional status of COVID-19 critically-ill patients: A prospective observational study from ICU admission to three months after ICU discharge

et al. 2022

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“…First of all, the SARS‐CoV‐2 infection can cause major inflammation, particularly pronounced in patients with severe and critical COVID‐19 disease 2 . Endothelial and epithelial cell death combined with vascular leakage can trigger production of chemokines and cytokines, and may result in a massive inflammatory reaction causing disturbed tissue homeostasis 1,3,4 . Acute phase proteins such as: TNFα, ferritin, C‐reactive protein (CRP), fibroblast growth factor, IL‐factors, NF‐κB, interferon‐γ are produced manifold and circulated, causing further dysregulation of metabolism and proteolysis 4 …”

Section: Weight Loss During Covid‐19mentioning

confidence: 99%

Weight loss, malnutrition, and cachexia in COVID‐19: facts and numbers

Anker

Landmesser

Haehling

et al. 2020

J cachexia sarcopenia muscle

113

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Patients with COVID‐19 disease are prone to develop significant weight loss and clinical cachexia. Three reports with altogether 589 patients that reported on weight loss and cachexia in COVID‐19 were identified. Disease severity of patients and the timing of the assessment during the disease course in these patients were variable—65 patients (11%) were intensive care treated at the time of assessment, and 183 (31%) were cared for in sub‐intensive or intermediate care structures. The frequency of weight loss ≥5% (that defines cachexia) was 37% (range 29–52%). Correlates of weight loss occurrence were reported to be raised C‐reactive protein levels, impaired renal function status, and longer duration of COVID‐19 disease. Underweight status by WHO criteria (BMI < 18.5 kg/m2) was only observed in 4% of patients analysing data from seven studies with 6661 patients. Cachexia assessment in COVID‐19 needs assessment of weight loss. COVID‐19 associated cachexia is understood to affect muscle and fat tissue as is also seen in many other chronic illness‐associated forms of cachexia. There are many factors that can contribute to body wasting in COVID‐19, and they include loss of appetite and taste, fever and inflammation, immobilization, as well as general malnutrition, catabolic–anabolic imbalance, endocrine dysfunction, and organ‐specific complications of COVID‐19 disease such as cardiac and renal dysfunction. Treatment of COVID‐19 patients should include a focus on nutritional support and rehabilitative exercise whenever possible. Specific anti‐cachectic therapies for COVID‐19 do not exist, but constitute a high medical need to prevent long‐term disability due to acute COVID‐19 disease.

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“…A major clinical feature of cachexia in adults is weight loss, which has been linked to inflammation and loss of appetite [ 27 ]. COVID-19-induced gastrointestinal symptoms, anorexia, and cytokine storm are known to cause weight loss and to trigger cachexia [ 28 ]. While no measurements of skeletal muscle mass were conducted in the present study, weight loss during treatment for COVID-19 can be attributed to cachexia, which is believed to lead to a decrease in the strength of swallowing-related muscles and to have effects on swallowing function [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Infection-Related Weight Loss Decreases Eating/Swallowing Function in Schizophrenic Patients

et al. 2021

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Background: In older people with psychoneurological diseases, COVID-19 infection may be associated with a risk of developing or exacerbating dysphagia. The aim of the present study was to examine the relationship between eating/swallowing function and COVID-19 infection. Methods: Subjects were 44 inpatients with confirmed COVID-19 infection being treated for schizophrenia in a psychiatric ward. Eating function was assessed using the Food Intake Level Scale (FILS) before and after infection. We also evaluated age, comorbidities, COVID-19 hospital stay, obesity index, weight loss rate, and chlorpromazine equivalent. Results: Subjects had a mean age of 68.86 years. Pre-infection, 20 subjects had a FILS score of 7–9 (presence of eating/swallowing disorder) and 24 subjects had a score of 10 (normal). Eating function after infection resolution showed decreasing FILS score compared to that before infection in 14 subjects (74.14 years). Six subjects (79.3 years) transitioned from oral feeding to parenteral feeding. A ≥ 10% weight loss during infection treatment was significantly associated with decreased eating function and a transition to parenteral feeding. Chlorpromazine equivalents, comorbidities, and number of days of hospitalization showed no associations with decreased eating function. Conclusions: Preventing malnutrition during treatment for COVID-19 infection is important for improving post-infection life prognosis and maintaining quality of life (QOL).

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Can COVID-19 be a risk for cachexia for patients during intensive care? Narrative review and nutritional recommendations

Cited by 29 publications

References 88 publications

Evolution of the nutritional status of COVID-19 critically-ill patients: A prospective observational study from ICU admission to three months after ICU discharge

Evolution of the nutritional status of COVID-19 critically-ill patients: A prospective observational study from ICU admission to three months after ICU discharge

Weight loss, malnutrition, and cachexia in COVID‐19: facts and numbers

COVID-19 Infection-Related Weight Loss Decreases Eating/Swallowing Function in Schizophrenic Patients

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