S1430 Early Enteral Nutrition Reduces In-Hospital Mortality of Critically Ill COVID-19 Patients

Abstract

Introduction: Early enteral nutrition (EEN) is a therapeutic strategy that is used in critical illness to reduce morbidity and mortality. There is no data on the role of nutrition therapy for intubated critically ill COVID-19 patients. The aim of our study was to assess if early enteral nutrition reduced morbidity and mortality during the first wave of the COVID-19 pandemic. Methods: A retrospective chart review of COVID-19 patients >18 years who were mechanically ventilated for >48 hours at Montefiore Medical Center from March 2020 to November 2020 (n = 669) was performed. Using a landmark analysis approach, patients were divided into (1) an EEN group, defined as having enteral feeding initiated before 48 hours of mechanical ventilation; (2) delayed or no enteral nutrition ( >48 hours of mechanical ventilation). Patients who died or were extubated prior to the landmark time were excluded. Cumulative incidence curves stratified by EEN status were estimated for the primary endpoint of in-hospital death, accounting for the competing risk of discharge. Secondary analysis examined time to extubation. Cox PH models were estimated to examine the association between EEN and the hazard of death while adjusting for an a priori set of COVID-related predictors. Two-sided p-values ≤ 0.05 were considered statistically significant. All analyses were conducted using SAS version 9.4 (SAS Institute Inc., Cary NC, USA). Results: There were 515 patients in the EEN group and 154 patients in the delayed enteral nutrition group. EEN was associated with a lower hazard of in-hospital death (adjusted HR = 0.79, 95% CI: 0.63-1.0; P = 0.05). Older age, male gender, and CKD were significantly associated with a higher hazard of death. The cumulative incidence of mortality was lower in the EEN group, with an estimated incidence of 40% and 53% at 10 and 20 days compared to 47% and 60% with delayed EN. Time to extubation and hospital discharge were not associated with EEN. Conclusion: EEN helps treat critically ill patients to maintain gut integrity, modulate stress and the systemic immune response and attenuate disease severity. The lower risk of in-hospital death in the EEN group supports this therapeutic modality in critically ill intubated COVID-19 patients. Further analysis to assess barriers for EEN including prone positioning, fluid restriction, and use of vasopressors is an area of future research.Figure 1.: De Novo Patients and Patients With Prior Diagnoses of EG and/or EoD Have Significant Reductions in Symptoms Compared With Patients Given Placebo.Table 1.: Cause-specific Cox PH model for the time to death from landmark time of 48 hours post intubation.