ÖZET
Amaç:
Bu çalışmadaki amacımız, koronavirüs hastalığı-2019'lu (COVİD-19) kritik hastaların yoğun bakım ünitesinde (YBÜ) tedavi edilirken hedeflenen kaloriye (ATC) ulaşıp ulaşmadığını ve bunun modifiye nutrik skoru (mNUTRIC) ve mortalite ile ilişkisini incelemekti.
Gereç ve Yöntem:
Hastalar YBÜ’de kaldıkları süre içerisinde hedeflenen kaloriye ulaşılıp ulaşılmadığına (ATC grubu) ve sağlanamamasına (NATC grubu) göre iki gruba ayrıldı. Hastaların mNUTRIC skorları, YBÜ ve hastane mortalite oranları her iki grup için karşılaştırıldı.
Bulgular:
ATC grubundaki hasta sayısı 59 (%63,4), NATC gruptaki hasta sayısı ise 34 (%36,6) idi. Başvuru anında mNUTRIC puanları ATC grubunda 3 (2-4) ve NATC grubunda 5 (4-6) olarak bulundu. Çok değişkenli regresyon analizinde mNUTRIC puanı 5 ve üzeri (p<0,01), hemodinamik instabilite (p=0,02) ve erkek cinsiyet (p=0,04) NATC için bağımsız risk faktörleri olarak anlamlı bulundu. YBÜ ve hastane mortalitesi NATC grubunda ACT grubuna göre daha yüksekti (sırasıyla p<0,01, p<0,03).
Sonuç:
YBÜ’de tedavi edilen kritik durumdaki COVİD-19 hastalarında hedeflenen kaloriye ulaşamama ve yüksek mNUTRIC puanı mortalite ile ilişkilendirilebilir.
References
1
Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis 2020;34:101623.
2
Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8:475-81.
3
Hellewell J, Abbott S, Gimma A, Bosse NI, Jarvis CI, Russell TW, et al. Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts. Lancet Glob Health 2020;8:e488-96.
4
Armitage R, Nellums LB. COVID-19 and the consequences of isolating the elderly. Lancet Public Health 2020;5:e256.
5
Li XY, Du B, Wang YS, Kang HYJ, Wang F, Sun B, et al. [The keypoints in treatment of the critical coronavirus disease 2019 patient(2)]. Zhonghua Jie He He Hu Xi Za Zhi 2020;43:277-81.
6
Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA 2020;323:1574-81.
7
Thibault R, Seguin P, Tamion F, Pichard C, Singer P. Nutrition of the COVID-19 patient in the intensive care unit (ICU): a practical guidance. Crit Care 2020;24:447.
8
Li G, Zhou CL, Ba YM, Wang YM, Song B, Cheng XB, et al. Nutritional risk and therapy for severe and critical COVID-19 patients: A multicenter retrospective observational study. Clin Nutr 2021;40:2154-61.
9
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-29.
10
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-10.
11
Zhang P, He Z, Yu G, Peng D, Feng Y, Ling J, et al. The modified NUTRIC score can be used for nutritional risk assessment as well as prognosis prediction in critically ill COVID-19 patients. Clin Nutr 2021;40:534-41.
12
Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 2019;38:48-79.
13
Mechanick JI, Carbone S, Dickerson RN, Hernandez BJD, Hurt RT, Irving SY, et al. Clinical Nutrition Research and the COVID-19 Pandemic: A Scoping Review of the ASPEN COVID-19 Task Force on Nutrition Research. JPEN J Parenter Enteral Nutr 2021;45:13-31.
14
Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol 2020;17:259-60.
15
National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network; Rice TW, Wheeler AP, Thompson BT, et al. Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA 2012;307:795-803.
16
Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ 2020;368:m1091.
17
Li T, Zhang Y, Gong C, Wang J, Liu B, Shi L, et al. Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. Eur J Clin Nutr 2020;74:871-5.
18
Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239-42.
19
Armstrong RA, Kane AD, Cook TM. Outcomes from intensive care in patients with COVID-19: a systematic review and meta-analysis of observational studies. Anaesthesia 2020;75:1340-9.
20
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054-62.
21
Gu J, Han B, Wang J. COVID-19: Gastrointestinal Manifestations and Potential Fecal-Oral Transmission. Gastroenterology 2020;158:1518-9.
22
Cheung KS, Hung IFN, Chan PPY, Lung KC, Tso E, Liu R, et al. Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis. Gastroenterology 2020;159:81-95.
23
Farina N, Nordbeck S, Montgomery M, Cordwin L, Blair F, Cherry-Bukowiec J, et al. Early Enteral Nutrition in Mechanically Ventilated Patients With COVID-19 Infection. Nutr Clin Pract 2021;36:440-8.
24
Martindale R, Patel JJ, Taylor B, Arabi YM, Warren M, McClave SA. Nutrition Therapy in Critically Ill Patients With Coronavirus Disease 2019. JPEN J Parenter Enteral Nutr 2020;44:1174-84.
25
Reignier J, Boisramé-Helms J, Brisard L, Lascarrou JB, Ait Hssain A, Anguel N, et al. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet 2018;391:133-43.
26
Silva DFO, Lima SCVC, Sena-Evangelista KCM, Marchioni DM, Cobucci RN, Andrade FB. Nutritional Risk Screening Tools for Older Adults with COVID-19: A Systematic Review. Nutrients 2020;12:2956.
27
Rahman A, Hasan RM, Agarwala R, Martin C, Day AG, Heyland DK. Identifying critically-ill patients who will benefit most from nutritional therapy: Further validation of the “modified NUTRIC” nutritional risk assessment tool. Clin Nutr 2016;35:158-62.
28
Liu G, Zhang S, Mao Z, Wang W, Hu H. Clinical significance of nutritional risk screening for older adult patients with COVID-19. Eur J Clin Nutr 2020;74:876-83.
29
Osuna-Padilla IA, Rodríguez-Moguel NC, Aguilar-Vargas A, Rodríguez-Llamazares S. High nutritional risk using NUTRIC-Score is associated with worse outcomes in COVID-19 critically ill patients. Nutr Hosp 2021;38:540-4.
30
Beck FK, Rosenthal TC. Prealbumin: a marker for nutritional evaluation. Am Fam Physician 2002;65:1575-8.
31
Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med 2020;180:934-43.
