Crtical Care and Shock Journal

First-week energy deficit and mortality in critically ill Covid-19 patients

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Introduction: Risk factors for mortality of critically ill Coronavirus disease 2019 (Covid-19) were older age, use of a mechanical ventilator, high modified nutrition risk in critically ill (mNUTRIC) score, presence of comorbidities, lower body mass index (BMI), acute respiratory distress syndrome (ARDS), and energy deficit in an intensive care unit (ICU).

Methods: A retrospective cohort study was conducted in the ICU of Dr. Kariadi Central Hospital, Semarang, Indonesia from March to December 2020. Subjects were adult, confirmed Covid-19 patients, stayed in the ICU for 3 days or more. Secondary data collected were demographic and anthropometric data, respiratory support, comorbidity, partial pressure of oxygen (PaO2) to the fraction of inspired oxygen (FiO2) ratio, mortality, body mass index (BMI), mNUTRIC score, route of nutrition delivery, and energy deficit. Cut-off points for energy deficit at days 3, 5, and 7 were determined by the receiver operating characteristic (ROC) curve. The calculation for relative risk followed by multiple logistic regression analysis measured risk for mortality.

Result: A total of 112 patient data were analyzed. Most subjects were male, aged <60 years old, had at least 1 comorbidity, had moderate or severe ARDS. The mortality rate was 50.9%. An energy deficit of 2000 kcal at day 3, 2975 kcal at day 5, and 3750 kcal at day 7 yielded a relative risk of 8.2, 6.6, and 2.5, respectively. The degree of ARDS, the use of mechanical ventilator, mNUTRIC score, and comorbidity were also significantly associated with mortality.

Conclusion: Energy deficit at the first week of ICU stay was a significant risk factor for mortality in critically ill Covid-19 patients.

Niken Puruhita, Febe Christianto, Luciana Sutanto, Banundari Rachmawati, Sofyan Harahap, Muchlis Adi Sofro, Retnaningsih, I. Riwanto, Hertanto W. Subagio


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