ABSTRACT
Patients transferred out of intensive care recovering from COVID-19 infection are at high risk of malnutrition1.Untreated malnutrition has the potential to increase length of stay and increase morbidity and mortality. To inform service planning we aimed to describe nutritional status and dietetic outcomes of patients recovering from COVID-19 infection post ICU admission. Baseline data was collected retrospectively from patient electronic records and included age, gender, comorbidities, weight, height, Body Mass Index (BMI), Vitamin D status, type of nutrition support, length of stay and discharge destination. Of 51 COVID-19 patients transferred out of ICU, 71% remained as inpatients and had further dietetic follow up. [Formula presented] Of those with data sets available, 82% had a decrease in weight during their ICU stay with an average loss of 7.6kg (9% body weight). Thirty percent moved into a lower BMI category over the course of their ICU stay. On discharge from hospital and dietetic service, 50% were weight stable and 29% had gained weight following dietetic input. Seventy two percent of patients required ongoing artificial nutrition support on transfer out of ICU. Prior to discharge home, 82% required advice on a high protein, high calorie diet with 25% of these requiring additional advice for therapeutic diets such as diabetic diets, no added salt diet, dietary advice for stoma management, renal dietary advice and modified consistency dietary advice. In terms of follow up, 11% were referred to community dietetics, 8% returned to dietetic outpatient clinics and 18% were stable on nutrition care plan and discharged from dietetic caseload at ward level. The data obtained highlights the deterioration in nutritional status and risk of malnutrition in this cohort of patients post COVID-19 infection. Ongoing nutrition support and dietetic input should be considered as integral on transfer from ICU to ward level in preventing, treating and diagnosing malnutrition. References 1. Bedock.D, Bel Lassen.P, Mathian.A, Moreau.P, Couffignal.J, Ciangura.C, Poitour-Bernert.C, Jeannin, AC, Mosbah.h, Fadlallahj, Amoura.Z, Oppert.JM, Faucher.P. Prevalence and severity of malnutrition in hospitalized COVID-19 patients. Clinical Nutrition ESPEN. 2020;Vol. 40 214-219 2. Haraj.NE, EL Aziz.S, Chadli. A, Dafir.A, Mjabber. A, Aissaoulo, Barrou.L, EL Kettanie EL Hamidi.C, Nsiri.A, AL Harrar.R, Ezzouine.H, Charra.B, Abdallaoui. Ms, EL Kebbaj.N, Kamal.N, Mohamed Bennouna.M, EL Filali.KM, Ramdani.B, EL Mdaghri.N, Benghanem Gharbim, Hicham Afif. Nutritional status assessment in patients with COVID-19 after discharge from intensive care unit. Clinical Nutrition ESPEN. 2020;2405-4577
ABSTRACT
Patients recovering from COVID-19 are at high risk of malnutrition, reduced nutritional intake and decline in muscle mass and strength with many requiring significant rehabilitation. The aim of this service evaluation is to quantify the risk of malnutrition and provide an overview of nutritional status and outcomes with dietetic input on a care of the elderly rehab ward. Demographics were collected from patient electronic records. Malnutrition risk, handgrip strength and Vitamin D levels were measured along with calculation of nutritional requirements. Of sixteen patients on the rehab wards post COVID-19, 81% (n=13) required dietetic input. [Formula presented] There was an average weight loss of 5.1kg (6.6%) (p=0.64). Eighty one percent had a reduction in their BMI, with 31% moving into a lower BMI category. Measurably reduced and impaired muscle function was evident when handgrip strength was measured. Eighty five percent required oral nutrition support. Additional advice for dysphagia, diabetes and renal disease was provided to 65% of patients. Following dietetic intervention, energy and protein intake improved in all patients. Sixty four percent were either insufficient or deficient in Vitamin D. The data obtained demonstrates the high prevalence of malnutrition in patients on a rehab ward post COVID-19. Furthermore the data highlights the clear need for dietetic intervention in this nutritionally vulnerable group to optimize nutritional status. References I. Stam. HJ, Stucki.G, Bickenbach.J. COVID-19 and post intensive care syndrome: A call for action. Journal of Rehabilitation Medicine. 2020;52 (4)
ABSTRACT
Patients recovering from COVID-19 infection are at a high risk of malnutrition, reduced nutritional intake and decline in muscle mass and strength.1 The aim of this service evaluation is to describe baseline characteristics, quantify risk of malnutrition, provide an overview of nutritional status and nutritional related outcomes for patients recovering post COVID-19 infection on rehabilitation wards. Data collection occurred between the 1st of February and the 1st of July 2021. This cohort included all patients who were recovering from COVID-19, who were referred to dietetic service and transferred to a rehabilitation ward. Demographic data and nutritional parameters were gathered from electronic records, and dietetic assessments. A total of 54 patients were included: 59% male, 41% female. Ages ranged from 46 to 95 years with average age of 79.9 years and average length of hospital stay of 92 days. One fifth of those included had an ICU stay. Where data was available on sarcopenia risk, 50% were identified as at risk of sarcopenia. Of those where serum 25-hydroxyvitamin D was checked, 45% had insufficient vitamin D levels. A nutrition focused physical exam was completed for 18 patients (one third of the cohort). Using this exam, 61% were diagnosed with moderate or severe malnutrition. At least 15% of patients experienced significant weight loss between their admission to the hospital compared to their weight on admission to post COVID-19 rehabilitation ward. Of those where Malnutrition Screening Tool was completed on admission to COVID-19 rehabilitation ward, 33% were identified as at risk of malnutrition. On discharge from the dietetic caseload, the proportion of those identified at risk of malnutrition using this tool decreased to 18%. During the period from admission to COVID-19 rehabilitation ward and discharge from dietetic service, 42% gained weight, 54% maintained their weight, 4% lost weight. Of those with data available regarding nutritional intake on admission to COVID-19 rehabilitation ward, 28% met energy requirements and 44% met protein requirements. On discharge from dietetic service these proportions increased to 66% meeting energy requirements and 74% meeting protein requirements. The average kcal intake on admission to COVID-19 rehabilitation increased from 1531kcal to 1778kcal on discharge and the average protein intake increased from 67g on admission to post COVID-19 rehabilitation to 75g on discharge. These results demonstrate the high prevalence of malnutrition and high risk of sarcopenia in patients admitted for rehabilitation post COVID-19 infection. With dietetic input, improvements were observed in patient’s nutritional intake, and nutritional outcomes such as weight and malnutrition risk. These results illustrate the need for early dietetic input in those recovering post COVID-19 infection to optimise nutritional status and nutritional outcomes. References: 1. Anker M. S., Landmesser U., von Haehling S et al. Weight loss, malnutrition, and cachexia in COVID-19: facts and numbers. Journal of Cachexia, Sarcopenia and Muscle, 12, 9– 13.
ABSTRACT
Rationale: Patients recovering from COVID-19 are at high risk of malnutrition, reduced nutritional intake and decline in muscle mass and strength with many requiring significant rehabilitation. The aim of this service evaluation is to quantify the risk of malnutrition and provide an overview of nutritional status and outcomes with dietetic input on a care of the elderly rehab ward. Methods: Demographics were collected from patient electronic records. Malnutrition risk, handgrip strength and Vitamin D levels were measured along with calculation of nutritional requirements. Results: Of sixteen patients on the rehab wards post COVID-19, 81% (n=13) required dietetic input. [Formula presented] There was an average weight loss of 5.1kg (6.6%) (p=0.64). Eighty one percent had a reduction in their BMI, with 31% moving into a lower BMI category. Measurably reduced and impaired muscle function was evident when handgrip strength was measured. Eighty five percent required oral nutrition support. Additional advice for dysphagia, diabetes and renal disease was provided to 65% of patients. Following dietetic intervention, energy and protein intake improved in all patients. Sixty four percent were either insufficient or deficient in Vitamin D. Conclusion: The data obtained demonstrates the high prevalence of malnutrition in patients on a rehab ward post COVID-19. Furthermore the data highlights the clear need for dietetic intervention in this nutritionally vulnerable group to optimize nutritional status. References: 1. Stam. HJ, Stucki.G, Bickenbach.J. COVID-19 and post intensive care syndrome: A call for action. Journal of Rehabilitation Medicine. 2020;52 (4) Disclosure of Interest: None declared.