Nutritional status of patients with critical illness myopathy and/or neuropathy after covid-19 from the viewpoint of physical rehabilitation

Abstract

Rationale: Patients admitted to rehabilitation after COVID-19 are at high nutritional risk (1). The aim of our study was to assess the frequency of nutritional disorders, associated conditions and laboratory changes (affecting nutritional and metabolic status) in patients with critical illness myopathy and/or neuropathy after COVID-19, and to analyse values of their body composition parameters in relation to physical abilities. Methods: The empirical prospective study included 30 patients with critical illness myopathy and/or neuropathy after COVID-19, hospitalized at the University Rehabilitation Institute, Republic of Slovenia, from November 2020 until March 2021. Laboratory parameters (albumin, anaemia, markers of inflammation, vitamin D) and body composition parameters (phase angle, hydration, fat-free mass index and dry lean mass) were monitored. Based on those parameters and clinical status (tests and instruments to assess muscle strength, functioning and independence, the latter using Functional Independence Measure - FIM), nutritional disorders and associated conditions were diagnosed. We prescribed medical nutrition therapy and monitored the patients until discharge. Univariate and bivariate statistical analyses were performed. Results: GLIM criteria for malnutrition were met in twenty-nine patients out of thirty, twenty-five of whom were severely malnourished (Grade 2). Most patients lost 11-15% of body mass during acute hospitalization (duration: mean 51, SD 15 days), some even more than 25%. Nineteen patients (63%) had associated conditions that affect the nutritional and metabolic status, mostly pressure sores. All patients had low phase angle (PA) at admission (mean 3.1, SD 0.5). Improvement in PA during rehabilitation was statistically significant (p<0.001), but the values were still below the fifth percentile of the healthy population. Correlation between PA and FIM was positive, but not statistically significant (r=0.3, p=0.141). Conclusion: The majority of our patients after COVID-19 are malnourished upon admission to rehabilitation, so an active screening for malnutrition is necessary. Optimal nutritional and metabolic management can contribute to a better rehabilitation outcome and higher level of independence after discharge.