Impact of COVID-19 in nutritional and functional status of survivors admitted in intensive care units during the first outbreak. Preliminary results of the NUTRICOVID study.

BACKGROUND & AIMS: COVID-19 patients present a high hospitalization rate with a high mortality risk for those requiring intensive care. When these patients have other comorbid conditions and older age, the risk for severe disease and poor outcomes after ICU admission are increased. The present work aims to describe the preliminary results of the ongoing NUTRICOVID study about the nutritional and functional status and the quality of life of adult COVID-19 survivors after ICU discharge, emphasizing the in-hospital and discharge situation of this population. METHODS: A multicenter, ambispective, observational cohort study was conducted in 16 public hospitals of the Community of Madrid with COVID-19 survivors who were admitted to the ICU during the first outbreak. Preliminary results of this study include data retrospectively collected. Malnutrition and sarcopenia were screened at discharge using MUST and SARC-F; the use of healthcare resources was measured as the length of hospital stay and requirement of respiratory support and tracheostomy during hospitalization; other study variables were the need for medical nutrition therapy (MNT); and patients' functional status (Barthel index) and health-related quality of life (EQ-5D-5L). RESULTS: A total of 176 patients were included in this preliminary analysis. Most patients were male and older than 60 years, who suffered an average (SD) weight loss of 16.6% (8.3%) during the hospital stay, with a median length of stay of 53 (27-89.5) days and a median ICU stay of 24.5 (11-43.5) days. At discharge, 83.5% and 86.9% of the patients were at risk of malnutrition and sarcopenia, respectively, but only 38% were prescribed MNT. In addition, more than 70% of patients had significant impairment of their mobility and to conduct their usual activities at hospital discharge. CONCLUSIONS: This preliminary analysis evidences the high nutritional and functional impairment of COVID-19 survivors at hospital discharge and highlights the need for guidelines and systematic protocols, together with appropriate rehabilitation programs, to optimize the nutritional management of these patients after discharge.

The devastating trio of sarcopenia, frailty, and COVID-19 - A systematic review and meta-analysis.

BACKGROUND & AIMS: Sarcopenia, frailty, and COVID-19 appear to be intertwined. Preventive and intervention measures are required to break this link and mitigate the consequences of rising morbidity and mortality among older adults. This study aimed to identify and synthesize important factors related to the interaction of the devastating trio and their impact on the health and mortality of older adults. METHODS: Data were gathered via searches of PubMed, Cochrane Library, Google Scholar, and Elsevier Mendeley Website. Study selection and data extraction were conducted by the two authors independently. The primary outcome was mortality, secondary outcomes included hospitalization and risk of development of severe disease among older Covid-19 patients. The study results are presented as adjusted odds and hazard ratios with 95% CI. RESULTS: A total of 1725 studies were identified through our electronic databases searches. After screening and assessing for eligibility, 39 studies were included in this review, a total of 51,796 patients were included in the systematic review. Our results indicated that frail patients recorded a higher mean age compared to non-frail patients (p < 0.00001), and COVID-19 frail patients had significantly increased mortality rate compared to non-frail patients, the log adjusted OR was 2.10 (1.63, 2.71); I2 = 78%; p < 0.00001. CONCLUSION: Age and frailty are important risk factors for mortality among older adults COVID-19 patients. COVID-19 patients with sarcopenia had a higher risk of developing severe conditions, including hospitalization and ICU admission. Findings that support the use of frailty and sarcopenia indicators to help in the decision-making process for medical care in older adults COVID-19 patients.

Frequency and factors associated with sarcopenia prediction in adult and elderly patients hospitalized for COVID-19.

Patients with COVID-19 may develop symptoms that interfere with food intake. Systemic inflammatory response associated with physical inactivity and/or immobilization during hospital stay can induce weight and muscle loss leading to sarcopenia and worsening the clinical condition of these patients. The present study identifies the frequency and factors associated with sarcopenia prediction in adult and elderly patients hospitalized for COVID-19. It is a cohort-nested cross-sectional study on adult and elderly patients admitted to wards and intensive care units (ICUs) of 8 hospitals in a northeastern Brazilian state. The study was conducted from June 2020 to June 2021. Sociodemographic, economic, lifestyle, and current and past clinical history variables were collected. Sarcopenia prediction was determined by the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire compiled in the Remote-Malnutrition APP (R-MAPP). Patients were diagnosed with sarcopenia when the final score ≥ 4 points. The study included 214 patients with a mean age of 61.76 ± 16.91 years, of which 52.3 % were female and 57.5 % elderly. Sarcopenia prevailed in 40.7 % of the sample. Univariate analysis showed greater probability of sarcopenia in elderly individuals, nonpractitioners of physical activities, hypertensive patients, diabetic patients, and those hospitalized in the ICU. In the multivariate model, the type of hospital admission remained associated with sarcopenia prediction, where patients admitted to the ICU were 1.43 (95 % CI: 1.04; 1.97) more likely to have sarcopenia than those undergoing clinical treatment. Sarcopenia prediction was not associated with patient outcome (discharge, transfer, or death) (p = 0.332). The study highlighted an important percentage of sarcopenia prediction in patients with COVID-19, especially those admitted to the ICU. Additional investigations should be carried out to better understand and develop early diagnostic strategies to assist in the management of sarcopenic patients with COVID-19.

The Effects of the 'Catabolic Crisis' on Patients' Prolonged Immobility after COVID-19 Infection.

Background and Objectives: Quarantine, isolation and bed rest associated with COVID-19 infection favored the loss of muscle and bone mass, especially in elderly patients. The current study aims to compare the presence of sarcopenia and osteoporosis in patients with a recent (one month) history of SARS-CoV-2 infection versus the general population. Materials and Methods: A cross-sectional study was conducted in which 157 patients were enrolled, divided into two groups, comparable in structure. The COVID-19 group (group C) consisted of 86 patients who were diagnosed with SARS-CoV-2 respiratory infection within the last 30 days. The non-COVID-19 group (group NC) consists of 71 patients who had no clinical signs of respiratory infection and were not quarantined/hospitalized in the last 3 months. Muscle strength, incidence of sarcopenia (using SARC-F score) and osteoporosis (DEXA determination) and physical performance (SPPB score) in the two groups were assessed and compared. Results: No statistically significant differences were found between the SPPB scores of the C group versus the NC group. Statistically significant differences were found in the evaluation of three parameters included in the SARC-F score. Patients in the C group had difficulties in standing up from a chair (p = 0.009) and climbing stairs (p = 0.030) due to lower muscle strength (p = 0.002) compared with patients in the NC group. No correlation of the SARC F and SPPB scores with the T score values obtained by osteo-densitometry was found. Conclusions: The sudden and significant reduction in physical activity, through various measures taken in the general population during the pandemic, led to an increased incidence of sarcopenia, both in patients who did not have COVID-19 infection and among those quarantined/hospitalized for this condition.

Social Detachment Influenced Muscle Mass and Strength during the COVID-19 Pandemic in Japanese Community-Dwelling Older Women.

Social detachment due to coronavirus disease (COVID-19) has caused a decline in physical activity, leading to sarcopenia and frailty in older adults. This study aimed to compare muscle mass, strength, and function values in older women before and after the first wave of the COVID-19 pandemic (April-May 2020). Furthermore, changes in muscle measures across women who experienced different levels of impact on their social participation due to the COVID-19 pandemic were examined. Muscle mass (total, trunk, and appendicular muscle), grip strength, oral motor skills, social interactions (social network and participation), and social support were assessed in 46 Japanese community-dwelling older women (mean, 77.5 y; range 66-93 y) before and after the first wave of the COVID-19 pandemic. Trunk muscle mass significantly decreased after the first wave of the pandemic. When comparing changed values between the enhanced/maintained and reduced group during the pandemic, significant group difference was observed in trunk muscular mass, grip strength, and oral motor skills. Intriguingly, those who enhanced social participation had a positive change of grip strength values, showing that social participation might influence muscle function during the COVID-19 pandemic.

[Nutritional management of the critically ill inpatient with COVID-19. A narrative review]. / Manejo nutricional del paciente hospitalizado críticamente enfermo con COVID-19. Una revisión narrativa.

INTRODUCTION: The current COVID-19 pandemic mainly affects older people, those with obesity or other coexisting chronic diseases such as type-2 diabetes and high blood pressure. It has been observed that about 20 % of patients will require hospitalization, and some of them will need the support of invasive mechanical ventilation in intensive care units. Nutritional status appears to be a relevant factor influencing the clinical outcome of critically ill patients with COVID-19. Several international guidelines have provided recommendations to ensure energy and protein intake in people with COVID-19, with safety measures to reduce the risk of infection in healthcare personnel. The purpose of this review is to analyze the main recommendations related to adequate nutritional management for critically ill patients with COVID-19 in order to improve their prognosis and clinical outcomes.

INTRODUCCIÓN: La pandemia actual por COVID-19 afecta principalmente a personas mayores, con obesidad o con otras enfermedades crónicas coexistentes como diabetes de tipo 2 e hipertensión arterial. Se ha observado que alrededor del 20 % de los pacientes requerirán hospitalización y algunos de ellos necesitarán soporte de ventilación mecánica invasiva en unidades de cuidados intensivos. El estado nutricional parece ser un factor relevante que influye en el resultado clínico de los pacientes con COVID-19 críticamente enfermos. Diversas guías internacionales han publicado recomendaciones para asegurar la ingesta energética y proteica de las personas con COVID-19, junto con medidas de seguridad para disminuir el riesgo de infección por parte del personal de salud. El propósito de esta revisión es analizar las principales recomendaciones relacionadas con el adecuado manejo nutricional del paciente hospitalizado críticamente enfermo con COVID-19 con la finalidad de mejorar el pronóstico y los resultados clínicos.