[Nutritional management of the critically ill inpatient with COVID-19. A narrative review]

Evolution of nutrition support in patients with COVID-19 disease admitted in the Intensive Care Unit

INTRODUCTION

Nutritional support in patients with COVID19 can influence the mean stay and complications in the patient in Intensive Care Unit (ICU).

AIMS

To evaluate the selection of enteral nutritional treatment in the COVID-19 patient admitted to the ICU. To know the development of dysphagia and its treatment. To evaluate the adjustment to the requirements and its relationship with the patient's complications.

MATERIAL AND METHODS

One-center longitudinal retrospective study in 71 patients admitted to the ICU with COVID19 infection and complete enteral nutrition between March and April 2020. Clinical variables were collected: length of stay in ICU, mean stay and rate of complications; and estimated anthropometric variables.

RESULTS

The mean age was 61.84 (13.68) years. Among the patients analyzed, 33 (46.5%) died. The median stay in the ICU was 20 (15.75-32) days and the mean stay was 37 (26.75-63) days. The type of formula most prescribed was normoprotein 24 (35.3%) and diabetes-specific 23 (33.8%) depending on the prescribed formula. There was no difference in mean stay (p = 0.39) or death rate (p = 0.35). The percentage of achievement of the estimated protein requirements was 50 (34.38-68.76). At discharge, 8 (21%) of the patients had dysphagia. A relationship was observed between the mean ICU stay and the probability of developing dysphagia (OR: 1.035 (1.004-1.07); p = 0.02).

CONCLUSIONS

In the patient with COVID19 disease admitted to the ICU, only half of the necessary protein requirements were reached. The presence of dysphagia at discharge was related to the length of time the patient was in the ICU.

[Evolution of nutrition support in patients with covid19 disease admitted in the intensive care unit]

Introducción

El soporte nutricional en el enfermo COVID-19 ingresado en Unidad de Cuidados Intensivos (UCI) puede influir en la evolución durante la hospitalización y al alta.

Objetivos

Evaluar la selección del tratamiento nutricional enteral en el paciente con infección COVID-19 ingresado en UCI. Conocer el desarrollo de disfagia y su tratamiento. Evaluar el ajuste a los requerimientos y su relación con las complicaciones del paciente.

Material y métodos

Estudio retrospectivo longitudinal unicéntrico en 71 pacientes ingresados en UCI con infección COVID que recibieron nutrición enteral total entre marzo y abril de 2020. Se recogieron datos de estancia en UCI, estancia media y tasa de complicaciones; variables antropométricas estimadas y diagnóstico de disfagia.

Resultados

La edad media fue de 61,84 (13,68) años. Entre los pacientes analizados fallecieron 33 (46,5%). La mediana de estancia en UCI fue de 20 (15,75-32) días y la estancia media fue de 37 (26,75-63) días.

El tipo de fórmula más prescrita fue la normoproteica (24 [35,3%]) y la específica de diabetes (23 [33,8%]). No hubo diferencia en la estancia media (p = 0,39) o en la tasa de éxitus (p = 0,35) en función de la fórmula prescrita. El porcentaje de consecución de los requerimientos proteicos estimados fue del 50% (34,38-68,76).

Al alta, 8 (21%) de los pacientes tenían disfagia. Se observó un aumento en el riesgo de disfagia en función de la estancia media en UCI (OR: 1,035 [1,004-1,07]; p = 0,02).

Conclusiones

En el paciente con infección COVID-19 en UCI únicamente se alcanzaron la mitad de los requerimientos proteicos necesarios en una situación de estrés. La presencia de disfagia al alta se relacionó con el tiempo que el paciente estuvo en la UCI.

The prevalence and risk factors of sarcopenia in patients with type 2 diabetes mellitus: a systematic review and meta-analysis

BACKGROUND

Sarcopenia was a frequent chronic complication in patients with type 2 diabetes mellitus (T2DM), and previous evidence showed conflicting results regarding the prevalence and risk factors of sarcopenia in T2DM. In the current study, we aimed at systematically exploring the prevalence and risk factors of sarcopenia in patients with T2DM.

METHODS

PubMed, Embase, and Cochrane Central Register of Controlled Trials were systematically searched to identify observational studies which investigated the prevalence and risk factors of sarcopenia in patients with T2DM. The quality of individual included studies was evaluated using The Newcastle-Ottawa scale. Pooled effects regarding prevalence and associated factors were calculated using random-effects models. The potential publication bias was assessed via funnel plot and Egger test.

RESULTS

Twenty-eight studies involving 16,800 patients were included in our meta-analysis. The pooled prevalence of sarcopenia in patients with T2DM was 18% (95% CI 0.15-0.22; I² = 97.4%). The pooled results showed that elder age (OR 4.73; 95% CI 4.30-5.19; I² = 85.6%), male gender, chronic hyperglycemia (higher HbA1c) (OR 1.16; 95% CI 1.05-2.47; I² = 99.2%) and osteoporosis (OR 1.16; 95% CI 1.05-2.47; I² = 99.2%) was predictors for sarcopenia, whereas patients with lower BMI (OR 1.16; 95% CI 1.05-2.47; I² = 99.2%) and metformin administrations (OR 1.16; 95% CI 1.05-2.47; I² = 99.2%) were not prone to get sarcopenia. The funnel plot and statistical tests showed no obvious publication bias.

CONCLUSIONS

Sarcopenia was frequent in T2DM patients. Elder age, male gender and chronic hyperglycemia, Osteoporosis were significant risk factors for Sarcopenia. Lower BMI and metformin administrations were associated with lower risk of sarcopenia.