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

Summary

Background & aims: Malnutrition is prevalent among COVID-19 patients admitted to the intensive care unit (ICU) and it is associated with poor survival. Customized nutrition plays a vital role in enhancing outcomes for this patient population. This study explores the association between energy and protein intake and 90-day mortality in invasively mechanically ventilated COVID-19 patients, utilizing fat-free mass (FFM) and actual body weight (ABW) for nutritional requirements. Furthermore, the study investigates the occurrence of gastrointestinal (GI) intolerance in critically ill COVID-19 patients in relation to their nutritional intake and survival. Methods: A retrospective study was undertaken at a university-affiliated teaching hospital, focusing on COVID-19 patients on invasive mechanical ventilation admitted to the ICU between March 2020 and December 2021. The study collected demographic and clinical data, along with cumulative energy and protein goals, and recorded cumulative intake on days 4, 7, and throughout the ICU stay. Univariate and multivariable Cox regression analyses were conducted to evaluate associations between energy and protein deficits and the 90-day all-cause mortality. Results: The study included 85 patients, of whom 67 (78 %) survived 90 days after ICU admission. There were no significant differences in body composition between survivors and non-survivors. Reaching ≥70 % of the energy goal based on both ABW and FFM during the ICU stay was associated with decreased 90-day mortality (HR 0.22, 95 % CI 0.08–0.60 and HR 0.28, 95 % CI 0.09–0.85, respectively). Similarly, achieving ≥80 % of the protein target based on FFM was associated with decreased 90-day mortality (HR 0.26, 95 % CI 0.07–0.94), whereas no significant association was found for reaching protein targets based on ABW (HR 0.03, 95 % CI 0.00–3.40). Patients who reached both their energy and protein goal based on FFM during ICU admission showed a lower risk of all-cause 90-day mortality compared to those who received <70 % of the energy goal and <80 % of protein based on FFM after adjusting for age (aHR 0.12, 95 % CI 0.03–0.50). No differences in GI intolerance related symptoms between COVID-19 survivors and non-survivors were observed. Conclusions: This study underscores the significance of providing adequate nutritional therapy to COVID-19 ICU patients who require IMV. Meeting over 80 % of the protein goals based on BIA-derived FFM was associated with lower mortality rates, which emphasizes the need for further investigation into the role of FFM in establishing nutritional targets.