ABSTRACT
Introduction et but de l'etude: The intensity and duration of the catabolic phase in COVID-19 patients might differ between survivors and non-survivors. The purpose of the study was to assess the association between nitrogen-balance trajectories and outcome in critically ill COVID-19 patients. Materiel et methodes: It is a retrospective monocentric observational study, achieved into the intensive care unit of the University Hospital of Clermont-Ferrand, France. Patients admitted to intensive care from January 2020 to May 2021 for COVID-19 pneumonia were included. Patients were excluded if referred from another ICU, if their ICU length of stay was < 72 h, or if they were treated with renal replacement therapy during the first seven days after ICU admission. Data were collected prospectively at admission and during ICU stay. Death was recorded at the end of ICU stay. Comparisons of nitrogen-balance time course according to outcome were made using two-way ANOVA. At days 3, 5, 7, 10 and 14, uni and multivariate logistic regression analyses were achieved to assess the impact of a non-negative nitrogen-balance on ICU death. At Days 3, 5 and 7, to represent the relationship between nitrogen-balance and protein intakes, linear and non-nonlinear models were run and the protein intakes necessary to reach a zero nitrogen-balance were determined. Subgroup analyses were carried out by BMI, age, and sex. Resultats et analyses statistiques: Ninety-nine patients were included. At Day 3, similar negative nitrogen-balances were observed in survivors and non-survivors: -16.4 g/d [-26.5, -3.3] and -17.3 g/d [-22.2, -3.8] (P = 0.54). The trajectories of nitrogen-balance over time thus differed between survivors and non-survivors (P = 0.01). In survivors, nitrogen-balance increased over time, whereas in non-survivors, nitrogen-balance decreased from Day 2 to Day 6, and thereafter increased slowly up to Day 14. At Day 5 and 7, a non-negative nitrogen-balance was protective from death. Administering higher protein amounts was associated with higher nitrogen-balances. Conclusion(s): We report a prolonged catabolic state in COVID patients that seemed more pronounced in non-survivors than in survivors. Our study underlines the need for monitoring urinary nitrogen excretion to guide protein intakes in COVID-19 patients.Copyright © 2023
ABSTRACT
PURPOSE: Evaluation of CT sarcopenia as a predictor of intensive care hospitalization during SARS-COV2 infection. MATERIALS AND METHODS: Single-center retrospective study of patients admitted to hospital with SARS-COV2 infection. The estimation of muscle mass (skeletal muscle index (SMI)) for sarcopenia, measurement of muscle density for muscle quality and body adiposity, were based on CT views on the T4 and L3 levels measured at admission. Demographic data, percentage of pulmonary parenchymal involvement as well as the orientation of patients during hospitalization and the risk of hospitalization in intensive care were collected. RESULTS: A total of 162 patients hospitalized for SARS-COV2 infection were included (92 men and 70 women, with an average age of 64.6 years and an average BMI of 27.4). The muscle area measured at the level of L3 was significantly associated with the patient's unfavorable evolution (124.4cm2 [97; 147] vs 141.5 cm2 [108; 173]) (p = 0.007), as was a lowered SMI (p < 0.001) and the muscle area measured in T4 (OR = 0.98 [0.97; 0.99]), (p = 0.026). Finally, an abdominal visceral fat area measured at the level of L3 was also associated with a risk of hospitalization in intensive care (249.4cm2 [173; 313] vs 147.5cm2 [93.1; 228] (p < 0.001). CONCLUSION: This study demonstrates that thoracic and abdominal sarcopenia are independently associated with an increased risk of hospitalization in an intensive care unit, suggesting the need to assess sarcopenia on admission during SARS-COV2 infection.