Individualised energy and protein targets achieved during intensive care admission are associated with lower mortality in mechanically ventilated COVID-19 patients: The COFEED-19 study

Nutritional Risk Score (NRS-2002) as a Predictor of In-Hospital Mortality in COVID-19 Patients: A Retrospective Single-Center Cohort Study

Background: Malnutrition is an often-overlooked yet potentially crucial factor influencing COVID-19 outcomes. Poor nutritional status weakens immune function, increases infection susceptibility, and worsens prognoses in hospitalized patients. However, its specific role in COVID-19 mortality remains insufficiently characterized. The aim of the study was to assess the impact of malnutrition, as determined by the Nutritional Risk Score (NRS-2002), on in-hospital mortality. Methods: This retrospective, single-center study analyzed 222 patients hospitalized with COVID-19 during the Delta variant predominance. Thirty-one patients died during hospitalization. Malnutrition (NRS ≥ 3) emerged as a strong predictor of in-hospital mortality in univariate Cox proportional hazard models, both before and after adjustment for potential confounders. Adjusted analyses used 10 different sets of three out of five mortality-related variables. Results: Hazard ratios for malnutrition ranged from 3.19 to 5.88 (p < 0.01 for all models), highlighting its substantial impact on mortality risk. The high Nagelkerke's R2 values (0.66-0.77) indicate that the models explained a significant proportion of mortality variance. Nutritional status plays a critical role in COVID-19 survival among hospitalized patients. Conclusions: Given its simplicity and effectiveness, integrating the NRS-2002 into routine clinical assessments may help identify high-risk patients early. Future research should explore whether early nutritional interventions can mitigate the mortality risks associated with malnutrition in severe COVID-19 cases or patients with other infectious diseases or acute inflammation.

Protein Delivery in Critical Care- What Have Recent Trials Shown Us?

Determining the optimal protein intake for intensive care unit (ICU) and post-ICU patients is a multifaceted challenge. Firstly, it is essential to avoid both underdosing (<1.0 g/kg) and overdosing (>1.6 g/kg) of actual protein intake. Secondly, the actual protein intake may deviate from the prescribed amount. Thirdly, phenotyping and endotyping are becoming increasingly crucial in tailoring protein targets. Additionally, a gradual increase in protein intake is essential during the first 4 to 5 days of ICU stay. Furthermore, no established protein targets exist for post-ICU patients, indicating the need for nutritional intervention research to identify optimal protein intake strategies.

The usefulness of a new indirect calorimeter in critically ill adult patients

BACKGROUND & AIMS

The use of indirect calorimetry to determine energy requirements is highly recommended in critically ill patients. To facilitate this a new and easy to use calorimeter (Q-NRG+, Cosmed) was developed. The primary aim of our study was to describe the usefulness of this calorimeter and, secondarily, to investigate the agreement between measured and predicted energy needs in a large cohort of critically ill adult patients.

METHODS

A prospective observational study was conducted among adult mechanically ventilated patients with COVID-19. Indirect calorimetry (Q-NRG+) to measure resting energy expenditure (mREE) was performed in the first week after admission and, wherever possible, repeated weekly. Reasons for not performing indirect calorimetry were reported. Parameters of indirect calorimetry and patient's conditions during the measurements were collected. Measurements were defined as valid if less than 10% overall variation in VO2 and VCO2 and respiratory quotient ranges between 0.67 and 1.1 were observed. mREE was compared with predictive REE (pREE) using standard formulas to explore hypo (<90%)-and hypermetabolism. (>110%). Bland-Altman method and two-way mixed intraclass correlation coefficients (ICC) (single measures) were used to assess the agreement between mREE and pREE.

RESULTS

Indirect calorimetric measurements were performed in 180 of the 432 admitted patients (42%). Of the 276 performed measurements 85% were valid, and of these 90% were used to tailor nutritional therapy. Most patients were male (71%), median age was 62 years [IQR 52; 70]. Logistical issues (absence of measuring staff, no device, no stock of disposables, MRSA isolation) and clinical issues (e.g Fio2>70%, detubated but still in ICU) were the main reasons for not performing indirect calorimetry. The majority of the REE-measurements indicated either hypo- or hypermetabolism (57% week 1 and 56% week 2). The correlation between mREE and pREE was very moderate (ICC = 0.527).

CONCLUSIONS

Although indirect calorimetry was performed in less than half of the patients, it proved to be of value to guide nutritional therapy. We conclude that the technique is easily applicable and expect that its impact can be significantly increased with the resolution of logistical and organizational issues.