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Hawryłkowicz V, Stasiewicz B, Maciejewska D, Sołek-Pastuszka J, Komorniak N, Skonieczna-Żydecka K, Martynova-Van Kley A, Stachowska E. The Link between Inflammation, Lipid Derivatives, and Microbiota Metabolites in COVID-19 Patients: Implications on Eating Behaviors and Nutritional Status. Int J Mol Sci 2024; 25:7899. [PMID: 39063142 PMCID: PMC11276903 DOI: 10.3390/ijms25147899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/13/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Extreme inflammation that continues even after infections can lead to a cytokine storm. In recent times, one of the most common causes of cytokine storm activation has been SARS-CoV-2 infection. A cytokine storm leads to dysregulation and excessive stimulation of the immune system, producing symptoms typical of post-COVID syndrome, including chronic fatigue, shortness of breath, joint pain, trouble concentrating (known as "brain fog"), and even direct organ damage in the heart, lungs, kidneys, and brain. This work summarizes the current knowledge regarding inflammation and the cytokine storm related to SARS-CoV-2 infection. Additionally, changes in lipid metabolism and microbiota composition under the influence of inflammation in COVID-19, along with the possible underlying mechanisms, are described. Finally, this text explores potential health implications related to changes in eating behaviors and nutritional status in COVID-19 patients. Although research on the cytokine storm is still ongoing, there is convincing evidence suggesting that severe immune and inflammatory responses during the acute phase of COVID-19 may lead to long-term health consequences. Understanding these links is key to developing treatment strategies and supporting patients after infection.
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Affiliation(s)
- Viktoria Hawryłkowicz
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland; (V.H.); (D.M.); (N.K.)
| | - Beata Stasiewicz
- Department of Human Nutrition, The Faculty of Food Science, University of Warmia and Mazury in Olsztyn, Sloneczna 45f, 10-718 Olsztyn, Poland
| | - Dominika Maciejewska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland; (V.H.); (D.M.); (N.K.)
| | - Joanna Sołek-Pastuszka
- Department of Anesthesiology and Intensive Care, Pomeranian Medical University, 71-242 Szczecin, Poland;
| | - Natalia Komorniak
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland; (V.H.); (D.M.); (N.K.)
| | | | | | - Ewa Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland; (V.H.); (D.M.); (N.K.)
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Pinheiro VE, Ribeiro AS, Camillo CAM, Casonatto J. Undernutrition risk is independently associated with worsened indicators of hospital rehabilitation in COVID-19 patients. Hosp Pract (1995) 2023; 51:267-274. [PMID: 37897431 DOI: 10.1080/21548331.2023.2277680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/25/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE This study was designed to analyze the association between the risk of undernutrition and indicators of hospital rehabilitation in patients with COVID-19 while controlling for confounding variables. METHODS This was an analytical study conducted by analyzing the medical records of patients with COVID-19. A total of 562 adult patients were eligible for the study. In addition to the risk of undernutrition (independent variable), indicators of hospital rehabilitation (dependent variables) were evaluated. These indicators included the length of hospital stay, clinical outcome (discharge or death), food intake, mobility (bedridden status), the use of mechanical ventilation, and the need for enteral nutrition. Pre-existing comorbidities (confounding/control variables) were grouped into cardiovascular, metabolic/endocrine, neurological, chronic obstructive pulmonary disease, and other categories (neoplasms, multiple sclerosis, and kidney disease). A dichotomization model was applied for data analysis. The Chi-Square test was used to verify the association between the risk of undernutrition and the dependent variables. Associations with a significance level of P < 0.05 were subjected to Poisson regression to identify the prevalence ratio. RESULTS Patients at risk of undernutrition had a 90% higher chance of being bedridden and were 35 times more likely to experience a decrease in food intake. They also had an 89% higher chance of using invasive mechanical ventilation and a 91% higher chance of requiring enteral nutrition. Additionally, individuals at risk of undernutrition had a 73% higher chance of death. Adjustment for comorbidities did not alter these associations, demonstrating that the risk of undernutrition is independently associated with indicators of hospital rehabilitation. CONCLUSION The risk of undernutrition is independently associated with worsened indicators of hospital rehabilitation in patients with COVID-19, including higher prevalence of mortality.
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Affiliation(s)
- Vanessa Esquissato Pinheiro
- Department of Health Sciences, University Pitágoras UNOPAR - Research Group in Physiology and Physical Activity - Londrina-Paraná-Brazil, Londrina, Brazil
| | - Alex Silva Ribeiro
- Department of Health Sciences, University Pitágoras UNOPAR - Research Group in Physiology and Physical Activity - Londrina-Paraná-Brazil, Londrina, Brazil
| | - Carlos Augusto Marçal Camillo
- Department of Health Sciences, University Pitágoras UNOPAR - Research Group in Physiology and Physical Activity - Londrina-Paraná-Brazil, Londrina, Brazil
| | - Juliano Casonatto
- Department of Health Sciences, University Pitágoras UNOPAR - Research Group in Physiology and Physical Activity - Londrina-Paraná-Brazil, Londrina, Brazil
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Nguyen LHT, Dang AK, Tran TV, Phan HT, Doan DAT, Nguyen LBT, Tran AM, Do TD, Nguyen TB, Nguyen TT, Nguyen BH, Le HT. The role of nutritional risk evaluation in predicting adverse outcomes among patients with severe COVID-19 in Vietnam. Front Nutr 2023; 10:1245816. [PMID: 37867496 PMCID: PMC10585166 DOI: 10.3389/fnut.2023.1245816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction As sufficient nutrition helps alleviate catabolic stress and modulate the systemic inflammatory response of the body, it plays an indispensable role in the good prognosis of critically ill patients. Thus, this study aimed to investigate the malnutrition of patients with severe COVID-19 and its association with adverse treatment outcomes. Methods We conducted a retrospective cross-sectional study in two provincial hospitals in Hanoi from February to April 2022. Participants were patients with severe COVID-19 admitted to the Intensive Care Unit (ICU). Malnutrition risk were evaluated by Nutritional Risk Screening-2002 (NRS), Global Leadership Initiative on Malnutrition (GLIM), Prognostic Nutritional Index (PNI), and the adverse prognosis was assessed by Acute Physiology and Chronic Health Evaluation II (APACHE II). The multivariate receiver-operating characteristic (ROC) curve was applied to estimate the predictive ability of those criteria regarding worse treatment results. Results The percentages of malnutrition measured by NRS, GLIM, PNI, and BMI were 62.6, 51.5, 42.9, and 16.6%, respectively. Patients with more severe malnutrition assessed by GLIM, PNI, and having above target fasting blood glucose (FBG) (≥10.0 mmol/L) were more likely to have higher APACHE scores. PNI had a better diagnostic performance than NRS and BMI (AUC = 0.84, 0.81, and 0.82, respectively). In addition, FBG revealed a good prognostic implication (AUC = 0.84). Conclusion A relatively high percentage of patients experienced moderate and severe malnutrition regardless of screening tools. Individuals at higher risk of malnutrition and high FBG were predicted to have more adverse treatment outcomes. It is recommended that nutritional screening should be conducted regularly, and personalizing nutritional care strategies is necessary to meet patients' nutrient demands and prevent other nutrition-related complications.
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Affiliation(s)
- Lan Huong Thi Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Department of Nutrition, Saint Paul General Hospital, Hanoi, Vietnam
| | - Anh Kim Dang
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, QLD, Australia
| | - Tien Viet Tran
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Hai Thanh Phan
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Dao Anh Thi Doan
- Department of Nutrition, Thanh Nhan General Hospital, Hanoi, Vietnam
| | - Lien Bao Thi Nguyen
- Intensive Care Unit and Poison Control, Saint Paul General Hospital, Hanoi, Vietnam
| | - Anh Minh Tran
- Department of Nutrition, Saint Paul General Hospital, Hanoi, Vietnam
| | | | - Thang Ba Nguyen
- Intensive Care Unit and Poison Control, Saint Paul General Hospital, Hanoi, Vietnam
| | - Tien Thanh Nguyen
- Department of Nutrition, Saint Paul General Hospital, Hanoi, Vietnam
| | - Binh Huy Nguyen
- Department of Physiology, Hanoi Medical University, Hanoi, Vietnam
| | - Huong Thi Le
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
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Feng X, Liu Z, He X, Wang X, Yuan C, Huang L, Song R, Wu Y. Risk of Malnutrition in Hospitalized COVID-19 Patients: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14245267. [PMID: 36558436 PMCID: PMC9780808 DOI: 10.3390/nu14245267] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/26/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
(1) Background: Studies have reported that COVID-19 may increase the risk of malnutrition among patients. However, the prevalence of such risk in hospitalized COVID-19 patients is uncertain due to the inconsistent use of assessment methods. (2) Methods: PubMed, Web of Science, and EMBASE were searched to identify studies on the nutritional status of hospitalized COVID-19 patients. A pooled prevalence of malnutrition risk evaluated by Nutrition Risk Score (NRS-2002) was obtained using a random effects model. Differences by study-level characteristics were examined by hospitalization setting, time of assessment, age, and country. Risk of bias was assessed using the Newcastle−Ottawa Scale. (3) Results: 53 studies from 17 countries were identified and summarized. A total of 17 studies using NRS-2002, including 3614 COVID-19 patients were included in the primary meta-analysis. The pooled prevalence of risk of malnutrition was significantly higher among ICU patients (92.2%, 95% CI: 85.9% to 96.8%) than among general ward patients (70.7%, 95% CI: 56.4% to 83.2%) (p = 0.002). No significant differences were found between age groups (≥65 vs. <65 years, p = 0.306) and countries (p = 0.893). (4) Conclusions: High risk of malnutrition is common and concerning in hospitalized patients with COVID-19, suggesting that malnutrition screening and nutritional support during hospitalization are needed.
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Affiliation(s)
- Xiaoru Feng
- Institute for Hospital Management, Tsinghua University, Beijing 100084, China
| | - Zeqi Liu
- Institute for Hospital Management, Tsinghua University, Beijing 100084, China
| | - Xiaotong He
- School of Labor and Human Resources, Renmin University of China, Beijing 100872, China
| | - Xibiao Wang
- Department of Occupational Hygiene Engineering, China University of Labor Relations, Beijing 100048, China
| | - Changzheng Yuan
- School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Liyan Huang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Rui Song
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - You Wu
- Institute for Hospital Management, Tsinghua University, Beijing 100084, China
- School of Medicine, Tsinghua University, Beijing 100084, China
- Correspondence: ; Tel.: +86-13641181601
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Koukaki E, Rovina N, Tzannis K, Sotiropoulou Z, Loverdos K, Koutsoukou A, Dimopoulos G. Fungal Infections in the ICU during the COVID-19 Era: Descriptive and Comparative Analysis of 178 Patients. J Fungi (Basel) 2022; 8:881. [PMID: 36012869 PMCID: PMC9410292 DOI: 10.3390/jof8080881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND COVID-19-associated fungal infections seem to be a concerning issue. The aim of this study was to assess the incidence of fungal infections, the possible risk factors, and their effect on outcomes of critically ill patients with COVID-19. METHODS A retrospective observational study was conducted in the COVID-19 ICU of the First Respiratory Department of National and Kapodistrian University of Athens in Sotiria Chest Diseases Hospital between 27 August 2020 and 10 November 2021. RESULTS Here, 178 patients were included in the study. Nineteen patients (10.7%) developed fungal infection, of which five had COVID-19 associated candidemia, thirteen had COVID-19 associated pulmonary aspergillosis, and one had both. Patients with fungal infection were younger, had a lower Charlson Comorbidity Index, and had a lower PaO2/FiO2 ratio upon admission. Regarding health-care factors, patients with fungal infections were treated more frequently with Tocilizumab, a high regimen of dexamethasone, continuous renal replacement treatment, and were supported more with ECMO. They also had more complications, especially infections, and subsequently developed septic shock more frequently. Finally, patients with fungal infections had a longer length of ICU stay, as well as length of mechanical ventilation, although no statistically significant difference was reported on 28-day and 90-day mortality. CONCLUSIONS Fungal infections seem to have a high incidence in COVID-19 critically ill patients and specific risk factors are identified. However, fungal infections do not seem to burden on mortality.
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Affiliation(s)
- Evangelia Koukaki
- ICU, 1st Department of Pulmonary Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikoletta Rovina
- ICU, 1st Department of Pulmonary Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Kimon Tzannis
- 2nd Propaedeutic Department of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Zoi Sotiropoulou
- ICU, 1st Department of Pulmonary Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Konstantinos Loverdos
- ICU, 1st Department of Pulmonary Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Antonia Koutsoukou
- ICU, 1st Department of Pulmonary Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - George Dimopoulos
- ICU, 1st Department of Pulmonary Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
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