Early caloric deficit is associated with a higher risk of death in invasive ventilated COVID-19 patients

Abstract

Background & Aims The aim of this study was to evaluate the nutritional support management in mechanically ventilated coronavirus disease 2019 (COVID-19) patients and explore the association between early caloric deficit and mortality, taking possible confounders (i.e. obesity) into consideration. Methods This was a prospective study carried out during the first pandemic wave in the intensive care units (ICUs) of two referral University Hospitals in Lombardy, Italy. Two hundred twenty-two consecutive mechanically ventilated COVID-19 patients were evaluated during the ICU stay. In addition to major demographic and clinical data, we recorded information on the route and amount of nutritional support provided on a daily basis. Results Among patients still in the ICUs and alive on day 4 (N=198), 129 (65.2%) and 72 (36.4%) reached a satisfactory caloric and protein intake, respectively, mainly by enteral route. In multivariable analysis, a satisfactory caloric intake on day 4 was associated with lower mortality (HR=0.46 [95%CI, 0.42-0.50], P<0.001). Mild obesity (body mass index [BMI] ≥30 and <35 kg/m 2 ) was associated with higher mortality (HR=1.99 [95%CI, 1.07-3.68], P=0.029), while patients with moderate-severe obesity (BMI≥35 kg/m 2 ) were less likely to be weaned from invasive mechanical ventilation (HR=0.71 [95%CI, 0.62-0.82], P<0.001). Conclusions This study confirmed the negative prognostic and clinical role of obesity in mechanically ventilated COVID-19 patients and suggested that early caloric deficit may independently contribute to worsen survival in this patients’ population. Therefore, any effort should be made to implement an adequate timely nutritional support in all COVID-19 patients during the ICU stay.

Nutritional parameters associated with prognosis in non-critically ill hospitalized COVID-19 patients: The NUTRI-COVID19 study

“…To our knowledge, the association explored herein had not been investigated in COVID-19 before, although it was already reported that hospitalized non-ICU patients satisfying their calorie-protein requirements were more frequently discharged than those who did not reach their nutritional targets [28]. Moreover, it was recently shown that early caloric deficit may independently contribute to worsening survival in mechanically ventilated COVID-19 patients [41].…”

Qualitative and quantitative muscle ultrasound changes in patients with COVID-19–related ARDS

“…A recent study on critically-ill patients with COVID-19-related acute respiratory failure showed how even achieving the supposed nutrition targets, the nitrogen balance remained negative by on average -9 grams of Nitrogen/day over the first week of stay [4] . Moreover, a recent prospective investigation showed how only about 70% of critically ill COVID-19 patients reached their caloric target on day 4, whereas less than 25% reached their protein target by the same day [38] . A recent longitudinal investigation showed how severe and critical COVID-19 patients showed a 30% reduction in rectus femoris cross-sectional area with an average 16.8% increase in echodensity from days 1 to 10 [39] .…”

Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance

“…Calories may be gradually increased up to estimated isocaloric needs of approximately 25 kcal/kg ABW$day after the first week, following individual evaluation based on clinical and hemodynamic conditions, as well as metabolic status and complications. A recent study notably provided initial direct evidence for the positive impact of preventing early caloric deficit to improve clinical outcomes in mechanically ventilated COVID-19 patients including overweight and obese BMI levels [178].…”