Relation between nutrition therapy in the acute phase and outcomes of ventilated patients with COVID-19 infection: a multicenter prospective observational study

Kensuke Nakamura; Junji Hatakeyama; Keibun Liu; Naoki Kanda; Kazuma Yamakawa; Takeshi Nishida; Shinichiro Ohshimo; Shigeaki Inoue; Satoru Hashimoto; Shuhei Maruyama; Daisuke Kawakami; Yoshitaka Ogata; Katsura Hayakawa; Hiroaki Shimizu; Taku Oshima; Tatsuya Fuchigami; Osamu Nishida

doi:10.1093/ajcn/nqac014

Relation between nutrition therapy in the acute phase and outcomes of ventilated patients with COVID-19 infection: a multicenter prospective observational study

Am J Clin Nutr. 2022 Apr 1;115(4):1115-1122. doi: 10.1093/ajcn/nqac014.

Authors

Kensuke Nakamura¹, Junji Hatakeyama², Keibun Liu³, Naoki Kanda¹, Kazuma Yamakawa⁴, Takeshi Nishida⁵, Shinichiro Ohshimo⁶, Shigeaki Inoue⁷, Satoru Hashimoto⁸, Shuhei Maruyama⁹, Daisuke Kawakami¹⁰, Yoshitaka Ogata¹¹, Katsura Hayakawa¹², Hiroaki Shimizu¹³, Taku Oshima¹⁴, Tatsuya Fuchigami¹⁵, Osamu Nishida¹⁶

Affiliations

¹ Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Japan.
² Department of Emergency and Critical Care Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
³ Critical Care Research Group, The Prince Charles Hospital, Chermside, Queensland, Australia.
⁴ Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan.
⁵ Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan.
⁶ Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
⁷ Department of Disaster and Emergency Medicine, School of Medicine, Kobe University, Hyogo, Japan.
⁸ Department of Intensive Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
⁹ Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, Osaka, Japan.
¹⁰ Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Hyogo, Japan.
¹¹ Department of Critical Care Medicine, Yao Tokushukai General Hospital, Osaka, Japan.
¹² Department of Emergency and Critical Care Medicine, Saitama Red Cross Hospital, Saitama, Japan.
¹³ Acute Care Medical Center, Hyogo Prefectural Kakogawa Medical Center, Hyogo, Japan.
¹⁴ Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
¹⁵ Intensive Care Unit, University of the Ryukyus Hospital, Okinawa, Japan.
¹⁶ Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan.

Abstract

Background: Optimal nutrition therapy has not yet been established for the acute phase of severe coronavirus disease 2019 (COVID-19) infection.

Objectives: We aimed to examine the effects of nutrition delivery in the acute phase on mortality and the long-term outcomes of post-intensive care syndrome (PICS).

Methods: A multicenter prospective study was conducted on adult patients with COVID-19 infection requiring mechanical ventilation during an intensive care unit (ICU) stay. Daily total energy (kcal/kg) and protein (g/kg) deliveries in the first week of the ICU stay were calculated. The questionnaire for PICS evaluation was mailed within a median of 6 mo after hospital discharge. The primary outcome was in-hospital mortality, and secondary outcomes were the PICS components of physical impairment, cognitive dysfunction, and mental illness.

Results: Among 414 eligible patients, 297 who received mechanical ventilation for 7 d or longer were examined. PICS was evaluated in 175 patients among them. High protein delivery on days 4-7 correlated with a low in-hospital mortality rate. In contrast, high protein delivery on days 1-3 correlated with physical impairment. A multivariate logistic regression analysis adjusted for age, sex, BMI, and severity revealed that average energy and protein deliveries on days 4-7 correlated with decreased in-hospital mortality (OR: 0.94; 95% CI: 0.89, 0.99; P = 0.013 and OR: 0.40; 95% CI: 0.17, 0.93; P = 0.031, respectively). Nutrition delivery did not correlate with PICS outcomes after adjustments. In the multivariate regression using a restricted cubic spline model, in-hospital mortality monotonically decreased with increases in average nutrition delivery on days 4-7.

Conclusions: In patents with COVID-19 on mechanical ventilation for ≥7 d, nutrition delivery in the late period of the acute phase was monotonically associated with a decrease in in-hospital mortality. Adequate protein delivery is needed on days 4-7.This trial was registered at https://www.umin.ac.jp as UMIN000041276.

Keywords: COVID-19; ICU-AW; PICS; energy; intensive care unit acquired weakness; nutrition; post-intensive care syndrome; protein.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
COVID-19* / therapy
Critical Illness / therapy
Humans
Intensive Care Units
Nutritional Support
Prospective Studies
Respiration, Artificial