ESPEN 2022 Late Breaking Abstracts

Topic: Nutritional assessment

Abstract Submission Identifier: ESPEN22-LB-2214

BODY COMPOSITION IN RELATION WITH TAILORED NUTRITIONAL SUPPORT AND CLINICAL OUTCOME IN CRITICALLY ILL COVID-19 PATIENTS

P. Lakenman^*, ¹, I. van Marwijk ¹, B. van der Hoven ², J. van Bommel ², J. Olieman ¹, K. Joosten ³

¹Department of Internal Medicine, Division of Dietetics, ²Department of Intensive Care Medicine, Erasmus MC, ³Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre - Sophia Children’s Hospital, Rotterdam, Netherlands

Rationale: Majority of critically ill COVID-19 patients suffer from malnutrition and weight loss  associated with negative clinical outcome. Our aim was to assess body composition (BC) during the acute and late phase of critical illness in COVID-19 patients in relation to tailored nutritional support and clinical outcome.

Methods: Observational study including adult COVID-19 patients during ICU stay. BC (fat mass (FM), fat-free mass (FFM), skeletal muscle mass (SMM), hydration status and phase angle (PA)) was measured with multifrequency bio-electrical impedance analyses during the acute (day 4) and late phase (day 10). Data on nutritional intake and requirements (determined with indirect calorimetry) were collected simultaneously. Clinical outcome was defined as length of ICU-stay and survival. Non-parametric tests were performed to compare BC in both phases and regression analyses to determine associations between BC, nutritional support and clinical outcome. 

Results: We included 70 patients (73% male, age 60 years [IQR 52-69]). Upon admission median BMI was 30kg/m² [IQR 26-33], of which 54% obese (BMI>30kg/m²). Median weight loss between day 4 and 10 was -3kg [IQR -5;0] consisting of -6kg FFM [IQR -10;-3] (consisting of -4kg SMM [IQR -6;-2]) and +3kg FM [IQR 0;7]. All these changes were significant (p<0.001). No significant associations between BC and clinical outcome were found. An increase of 10% administrated protein intake resulted in <1% difference (40g) of FFM (p=0.04), of which 20g SMM (p=0.05), and an increase of 50g FM (p=0.02). 

Conclusion: BC changed significantly during the acute and late phase, however no associations were found with clinical outcome in our population. Increasing the protein intake during these phases showed significant differences in the body composition, although clinical relevancy can be debated. 

References: Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clinical nutrition. 2019;38(1):48-79.

Disclosure of Interest: None Declared

Keywords: body composition, Clinical outcomes, Covid-19, Critically ill patients, Nutritional assessment