Published in Clinical Nutrition ESPEN, October 2021
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As more data is now available on the nutritional management of patients critically ill with COVID-19, this paper looks at the relationship between mortality and protein and energy intakes. This team from Brazil recognised that optimal nutrition support could dramatically affect the outcome and prognostics of a patient with COVID-19. Their study therefore aimed ‘to verify if there is an association between mortality rates and the amount of energy and protein provided to critically ill patients with SARS-CoV-2 and receiving enteral nutrition support’.
This is an observational, retrospective study (data collected March-December 2020) in which all adults patients confirmed with COVID-19, admitted onto ICU, hospitalised for more than 7 days and receiving enteral nutritional were enrolled. Demographic data, length of stay, days on mechanical ventilation, final clinical outcome (death or discharge from hospital) and daily energy and protein supplies was collected from electronic medical records.
Fifty-two patients (mean age 66.2 years, 54% female) were enrolled. The mean length of hospital stay was 17.8 days, with the final outcome of death for the majority of patients (73.1%, n38). The mean daily protein and energy supplied during the hospital period were 0.6 ± 0.3g/IBW/day and 9.1 ± 6.3kcal/IBW/day respectively. In the multivariate analysis, the hazard ratio for protein intake >0.8g/IBW/day was associated with significantly lower mortality (HR 0.322, p=0.049) but no association was seen for energy supply.
The authors acknowledge that this suggests a possible association between protein provided by enteral nutrition and mortality in critically ill patients with COVID-19. This is a relatively small and retrospective study so further data is required, however it does reinforce the message that adequate nutritional support should be a top priority for all patients critically ill with COVID-19.