Annals of medicine · 2025
Implementation of the nutrition care process on mortality risk in critically ill COVID-19 patients - a registry longitudinal cohort study.
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Woodcock Lindsay, Steiber Alexa, Fan Zhongqui, Louck Lauren E, Steiber Alison, Papoutsakis Constantina, Wallace Taylor C
Аннотация
BACKGROUND: COVID-19 impacts the nutritional status of patients. There is limited longitudinal research on the impact of nutrition care provided to COVID-19 patients in the intensive care unit (ICU).
OBJECTIVE: We assessed the real-world effectiveness of the nutrition care process (NCP) used by registered dietitian nutritionists (RDNs) on mortality in COVID-19 ICU patients.
METHODS: RDNs in 8 ICUs throughout the United States utilized the Academy of Nutrition and Dietetics Health Informatics Infrastructure (ANDHII) registry to document standard care practices, per the NCP, used with COVID-19 patients admitted from April 2021 to April 2022. Mortality, the primary outcome, was reported at the last visit. A multivariable logistic regression model, adjusted for sex, age, body mass index (BMI), and number of visits, estimated mortality risk as a function of the NCP problem status (improving/resolved).
RESULTS: Participants (N = 90) were mostly male (68.2%), with a mean age of 57.2 ± 15.7 years. Participants' baseline c-reactive protein (CRP) levels were high (55.9 ± 74.2 mg/L) and about two-thirds were obese (63.7%), per BMI. 33 patients died over the study duration. The most common NCP problems identified were related to inadequate energy and protein intake, with 62.5% resolved through enteral nutrition interventions. Improvement and resolution of the NCP problem by the RDN was associated with 86% (OR: 0.14, 95% CI: 0.03-0.52, p = 0.004) and 89% (OR: 0.11, 95% CI: 0.01-0.67, p = 0.023) reduced risk of death, respectively.
CONCLUSION: We show for the first time in a real-word setting that implementing the NCP to identify and address nutritional problems during ICU admission is associated with lower mortality risk in critical COVID-19 patients. Due to limitations in longitudinal registries and use of logistic models, future larger-scale cohorts and clinical trials are needed.
OBJECTIVE: We assessed the real-world effectiveness of the nutrition care process (NCP) used by registered dietitian nutritionists (RDNs) on mortality in COVID-19 ICU patients.
METHODS: RDNs in 8 ICUs throughout the United States utilized the Academy of Nutrition and Dietetics Health Informatics Infrastructure (ANDHII) registry to document standard care practices, per the NCP, used with COVID-19 patients admitted from April 2021 to April 2022. Mortality, the primary outcome, was reported at the last visit. A multivariable logistic regression model, adjusted for sex, age, body mass index (BMI), and number of visits, estimated mortality risk as a function of the NCP problem status (improving/resolved).
RESULTS: Participants (N = 90) were mostly male (68.2%), with a mean age of 57.2 ± 15.7 years. Participants' baseline c-reactive protein (CRP) levels were high (55.9 ± 74.2 mg/L) and about two-thirds were obese (63.7%), per BMI. 33 patients died over the study duration. The most common NCP problems identified were related to inadequate energy and protein intake, with 62.5% resolved through enteral nutrition interventions. Improvement and resolution of the NCP problem by the RDN was associated with 86% (OR: 0.14, 95% CI: 0.03-0.52, p = 0.004) and 89% (OR: 0.11, 95% CI: 0.01-0.67, p = 0.023) reduced risk of death, respectively.
CONCLUSION: We show for the first time in a real-word setting that implementing the NCP to identify and address nutritional problems during ICU admission is associated with lower mortality risk in critical COVID-19 patients. Due to limitations in longitudinal registries and use of logistic models, future larger-scale cohorts and clinical trials are needed.