Nutritional therapy in critically ill patients with diabetes

Summary OBJECTIVE: To investigate the prevalence of hypophosphatemia as a marker of refeeding syndrome (RFS) before and after the start of nutritional therapy (NT) in critically ill patients. METHODS: Retrospective cohort study including 917 adult patients admitted at the intensive care unit (ICU) of a tertiary hospital in Cuiabá-MT/Brasil. We assessed the frequency of hypophosphatemia (phosphorus <2.5mg/dl) as a risk marker for RFS. Serum phosphorus levels were measured and compared at admission (P1) and after the start of NT (P2). RESULTS: We observed a significant increase (36.3%) of hypophosphatemia and, consequently, a greater risk of RFS from P1 to P2 (25.6 vs 34.9%; p<0.001). After the start of NT, malnourished patients had a greater fall of serum phosphorus. Patients receiving NT had an approximately 1.5 times greater risk of developing RFS (OR= 1.44 95%CI 1.10-1,89; p= 0.01) when compared to those who received an oral diet. Parenteral nutrition was more associated with hypophosphatemia than either enteral nutrition (p=0,001) or parenteral nutrition supplemented with enteral nutrition (p=0,002). CONCLUSION: The frequency of critically ill patients with hypophosphatemia and at risk for RFS on admission is high and this risk increases after the start of NT, especially in malnourished patients and those receiving parenteral nutrition.

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The triglyceride-glucose index played an important role in prognosis in critically ill patients with heart disease

10.21203/rs.3.rs-819706/v1 ◽

2021 ◽

Author(s):

Guangyao Zhai ◽

Biyang Zhang ◽

Jianlong Wang ◽

Yuyang Liu ◽

Yujie Zhou

Keyword(s):

Heart Disease ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Binary Logistic Regression ◽

Independent Effect ◽

Binary Logistic Regression Analysis ◽

Triglyceride Glucose Index ◽

Increased Risk ◽

Patients With Diabetes

Abstract Background As an alternative method to evaluate insulin resistance (IR), triglyceride-glucose index (TyG) was shown to be related to the severity and prognosis of cardiovascular diseases. The main objective of this study was to explore the association between TyG and in-hospital mortality in critically ill patients with heart disease Method: TyG was calculated as previously reported: ln [fasting TGs (mg/dL) * FBG (mg/dL)/2]. All patients were divided into four different categories based on TyG quartiles. Primary outcome was in-hospital mortality. Binary logistic regression analysis was performed to determine the independent effect of TyG. Result 4839 critically ill patients with heart disease were included. In-hospital mortality increased as TyG quartiles increased (Quartile 4 vs Quartile 1: 12.1 vs 5.3, P < 0.001). Even after adjusting for confounding variables, TyG was still independently associated with the increased risk of in-hospital mortality in critically ill patients with heart disease (Quartile 4 vs Quartile 1: OR, 95% CI: 2,43, 1.79–3.31, P < 0.001, P for trend < 0.001). However, we did not observe the association between increased TyG and the risk of mortality in patients with diabetes. Furthermore, as TyG quartiles increased, the length of intensive care unit (ICU) stay was prolonged (Quartile 4 vs Quartile 1: 2.3, 1.3–4.9 vs 2.1, 1.3–3.8, P = 0.007). And the significant interactions were not found in most subgroups. Conclusion TyG was independently correlated with in-hospital mortality in critically ill patients with heart disease.

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Middle East Respiratory Syndrome in Critically Ill Patients with Diabetes: A Multicenter Observational Study of Clinical Presentation, Management and Outcomes

10.21203/rs.3.rs-57988/v1 ◽

2020 ◽

Author(s):

Jesna Jose ◽

Hasan Al-Dorzi ◽

Awad Al-Omari ◽

Yasser Mandourah ◽

Fahad Al-Hameed ◽

...

Keyword(s):

Regression Analysis ◽

Risk Factor ◽

Middle East ◽

Critically Ill ◽

Critically Ill Patients ◽

Independent Predictor ◽

Middle East Respiratory Syndrome ◽

Multivariable Logistic Regression Analysis ◽

Presenting Symptoms ◽

Patients With Diabetes

Abstract Background: Diabetes is a risk factor for infection with coronaviruses. This study describes the demographic, clinical data and outcomes of critically ill patients with diabetes who developed Middle East Respiratory Syndrome (MERS).Methods: This retrospective cohort study was conducted at 14 hospitals in Saudi Arabia (September 2012-January 2018). We compared the demographic characteristics, underlying medical conditions, presenting symptoms and signs, management and clinical course and outcomes between critically ill MERS patients who had diabetes and those with no diabetes. Multivariable logistic regression analysis was performed to determine if diabetes was an independent predictor of 90-day mortality.Results: Of the 350 MERS patients, 171 (48.9%) had diabetes, were more likely to be older and have comorbid conditions. Patients with diabetes were more likely to present with respiratory failure requiring intubation, vasopressors and corticosteroids. The median time to clearance of MERS-CoV RNA was similar (23 days (Q1, Q3: 17, 36) in patients with diabetes and 21.0 days (Q1, Q3: 10, 33) in patients with no diabetes. Mortality at 90 days was higher in patients with diabetes (78.9% versus 54.7%, p<0.0001). Multivariable regression analysis showed that diabetes was an independent risk factor for 90-day mortality (odds ratio, 2.09; 95% confidence interval, 1.18-3.72).Conclusions: Critically ill patients with diabetes constitute half of critically ill patients with MERS, presenting with more severe disease requiring mechanical ventilation compared to those who do not have diabetes. Diabetes is an independent predictor of mortality.

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Nutritional Therapy in Critically Ill Patients with COVID-19: A Narrative Review

Revista Española de Nutrición Humana y Dietética ◽

10.14306/renhyd.25.s2.1073 ◽

2021 ◽

Vol 25 ◽

pp. e1073

Author(s):

Larissa Gens Guilherme

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Hospital Setting ◽

Nutritional Therapy ◽

Narrative Review ◽

Current Evidence ◽

High Association ◽

Nutritional Recommendations ◽

Improve Clinical Outcome

Introduction: Combating the pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), better known as Coronavirus Disease 2019 (COVID-19), in all countries of the world has been a challenge. Most patients can be treated in home isolation, however elderly patients and/or with associated comorbidities have been demonstrating more severe conditions of the disease, requiring hospitalization, or even nutritional therapy and mechanical ventilation. Objective: To review the current evidence to establish better nutritional recommendations for critically ill patients with COVID-19.Material and methods:This is a narrative review on nutritional therapy in critical patient with COVID-19. The scientific articles were searched in the databases U.S. National Library of Medicine (PubMed), as well as their respective terms in Portuguese and Spanish, and 40 articles were chosen, excluding the guidelines that were used to help better compose this article.Results: The main findings were that age and non-communicable diseases are considered risk factors for mortality, with systemic arterial hypertension and diabetes mellitus being the main ones. These patients need special care, as well as constant assessment of nutritional status, since malnourished and obese patients have shown a high association with mortality and the use of mechanical ventilation. Nutritional therapy in the affected patients can improve clinical outcome and should be considered as first-line treatment and be more valued in the hospital setting. Although there is no recommendation for supplementation of vitamin C and D and the mineral zinc, these may bring benefits to the immune system of these patients and help in a better prognosis of COVID-19, however more studies are still needed to substantiate the dosage.Conclusions: Further studies are needed, but it is important to bring these themes already exposed by some authors to stimulate discussions that might lead to improvements in the standardization of nutritional approaches.

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