Association of protein-calorie intake and clinical outcomes among critically-ill COVID-19 patients: A retrospective study
- Author:
Maria Regina Paz K. Tanada
1
;
Mary Jane Tanchee-Ngo
2
Author Information
- Publication Type:Journal Article
- Keywords: Protein-calorie intake; OIutcome; Mechanically ventilated
- MeSH: COVID-19; Retrospective Studies; Critical Care
- From: Philippine Journal of Internal Medicine 2021;59(3):246-254
- CountryPhilippines
- Language:English
-
Abstract:
Background:Patients admitted due to severe COVID-19 pneumonia are at high risk for malnutrition and worsening of their
clinical condition. Patients with type 2 diabetes admitted for COVID-19 pneumonia have an increased risk for poor clinical outcomes. Adequate nutrition is recommended to augment a strong immune response. The American Society of Parenteral and Enteral Nutrition (ASPEN), Philippine Society of Parenteral and Enteral Nutrition (PHILSPEN), European Society of Parenteral and Enteral Nutrition (ESPEN) recommend an energy intake goal of 15-20 kcal/kg actual body weight (ABW) per day or 70-80% of caloric requirements after the acute phase of critical illness, with recommended protein intake of 1.2-2.0 g/kg ABW per day. This study aims to provide an association between calorie and protein intake with negative clinical outcomes.
Methods:This is a retrospective cohort study of 55 mechanically ventilated SARS COV-2 RT-PCR positive patients admitted in the critical unit of Chinese General Hospital between April 1, 2020 to December 30, 2020. Clinical profile taken include: sex, age, height weight, BMI, comorbidities, and components of the modified SOFA score and APACHE II score. Calorie and protein intake from day 3 to day 7 of ICU admission were taken. Clinical outcome data were in-hospital mortality, number of days of ICU stay, hospital admission, vasopressor use and mechanical ventilation.
Results:Majority of the patients included in the study were male, elderly, overweight, and with comorbidities such as hypertension, diabetes, and chronic kidney disease. Majority of the patients were on mechanical ventilation and on vasopressors for more than 1 week. In-hospital mortality accounted for 65.5% of cases. For patients without diabetes, calorie intake was 16.9 kcal/kg/day and protein intake was 0.72 g/kg/day, while patients with diabetes had a calorie intake of 20.2 kcal/kg/day and protein intake of 0.86 g/kg/day. Based on the 70% cutoff, patients with diabetes were noted to have been provided with more adequate protein (P-value= 0.027). Higher caloric intake was inversely associated with in-hospital mortality among patients younger than 75 years old (P-value=0.026) and among patients with diabetes (P-value=0.003). Higher calorie intake was also significantly associated with decreased duration of pressors among patients with diabetes (P-value=0.021). Higher protein intake positively associated with the number of days admitted among patients with lower modified SOFA scores (P-value=0.041) and among patients with diabetes (P-value=0.021). All other associations did not display significant results (all P-values>0.05).
Conclusion:Based on this study, increased caloric intake was associated with increased survival among patients less than 75 years, but no association was found in patients 75 years and older. Among patients with lower mortality risk, increased protein intake was associated with longer duration of hospital stay, however patients with higher risk had higher in-hospital mortality regardless of protein and calorie intake. Among patients with diabetes, higher calorie intake was associated with increased survival and decreased duration of pressor requirement, while increased protein was associated with longer length of hospital stay. Treatment for COVID-19 pneumonia, however, was not established at this time and there was significant in-hospital mortality among these mechanically ventilated patients. - Full text:9 Association.pdf
