Protein and Energy Intake Assessment and Their Association With In-Hospital Mortality in Critically Ill COVID-19 Patients: A Prospective Cohort Study.

Melika Hajimohammadebrahim-Ketabforoush,Maryam Vahdat Shariatpanahi,Shaahin Shahbazi,Erfan Shahbazi,Zahra Vahdat Shariatpanahi

doi:10.3389/fnut.2021.708271

Abstract

Background and Aim: It is partially known that nutritional intake could alleviate proteolysis and course of disease severity in patients with COVID-19; however, not enough data are available in this regard. The present study aimed to assess protein and energy intake and their association with in-hospital mortality in critically ill COVID-19 patients.Methods: A total of 126 patients with COVID-19, who were critically ill, ≥5 days and a subset of 111 patients in ICU ≥10 days completed the present prospective observational cohort study.Results: Protein and energy intakes on Day 5 of ICU admission in survivors were 46 and 58% of target values, respectively. These values in non-survivors were 42 and 50% of target values, respectively (p < 0.05). In the sample ≥10 days, protein and energy intakes in survivors reached 64 and 87% of target values, respectively, without statistically significant differences with non-survivors. In the sample ≥5 days, Cox proportional hazard regression was adjusted for GLIM, APACHE II, comorbidity, and age; the results indicated that the patients with protein and energy intake lower than 0.59 g/kg/day and 14 kcal/kg/day, had ~2-fold mortality hazard (protein: HR, 2.38; 95% CI, 1.40–4.03; P = 0.001 and energy: HR, 2.23; 95% CI, 1.27–3.92; P = 0.005).Conclusion: Actual protein and energy intakes in critically ill patients with COVID-19 are in suboptimal levels compared with goal recommendations in these patients. Moreover, higher amounts of protein and energy intakes in the early acute phase were significantly associated with better survival and lower risk of in-hospital mortality.

Highlights

The current terrible pandemic created by the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) has affected a huge number of people
In the patients who were hospitalized in intensive care unit (ICU) longer than 10 days (n = 111), protein and energy intakes in the survivors were .82 ± 0.12 g/kg/day and 21.81 ± 4.19 kcal/kg/day, which were approximately 64 and 87% of target values, respectively
Regardless of how long they stay in ICU, the median of protein and energy intake ratios was 60% (50.97–60) and 86.24% (73.11–95.42), respectively

Summary

Introduction

The current terrible pandemic (coronavirus disease 2019) created by the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) has affected a huge number of people. Certain studies on patients with other critical illness hospitalized in ICU have shown beneficial effects of greater protein [11, 12] and energy intake [13, 14] on various adverse clinical outcomes, yet other research have not reported any benefits [15]. There are other studies suggesting the harmful effects of increased delivery of protein [16] and energy [17] in critically ill patients Considering these controversial results, the scarce-related studies on patients with COVID-19, and evaluation of the outcomes during ICU stay and hospitalization, we conducted the current study to assess protein and energy intake and investigate their association with in-hospital mortality in critically ill patients with COVID-19. The present study aimed to assess protein and energy intake and their association with in-hospital mortality in critically ill COVID-19 patients

Methods

Results

Discussion

Conclusion