Nutritional parameters and outcomes in patients admitted to intensive care with COVID-19: a retrospective single-centre service evaluation
et al., BMJ Nutrition, Prevention & Health,
Nutritional parameters and outcomes in patients admitted to intensive care with COVID-19: a retrospective..
, BMJ Nutrition, Prevention & Health, doi:10.1136/bmjnph-2021-000270
Retrospective 72 ICU patients in the UK, showing higher mortality with vitamin D deficiency, not reaching statistical significance.
risk of death, 63.9% lower, RR 0.36, p = 0.10, high D levels (≥25nmol/L) 3 of 26 (11.5%), low D levels (<25nmol/L) 8 of 25 (32.0%), NNT 4.9.
risk of death, 92.9% lower, RR 0.07, p = 0.18, high D levels (≥50nmol/L) 0 of 8 (0.0%), low D levels (<50nmol/L) 11 of 43 (25.6%), NNT 3.9, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Eden et al., 5 Aug 2021, retrospective, United Kingdom, peer-reviewed, 5 authors.
Abstract: Open access
Timothy Eden,1,2 Shane McAuliffe ,2,3 Dominic Crocombe,2 Jonathan Neville,1
To cite: Eden T, McAuliffe S,
Crocombe D, et al. Nutritional
parameters and outcomes
in patients admitted to
intensive care with COVID-19:
a retrospective single-
centre service evaluation.
BMJ Nutrition, Prevention &
Health 2021;0. doi:10.1136/
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Dr Timothy Eden, ICU West,
Hammersmith Hospital, Imperial
College Healthcare NHS Trust,
London W12 0HS, UK;
Received 13 March 2021
Accepted 12 July 2021
© Author(s) (or their
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Background COVID-19 is an inflammatory syndrome
caused by novel coronavirus SARS-CoV-2. Symptoms
range from mild infection to severe acute respiratory
distress syndrome (ARDS) requiring ventilation and
intensive care. At the time of data collection, UK cases
were around 300 000 with a fatality rate of 13%
necessitating over 10 000 critical care admissions; now
there have been over 4 million cases. Nutrition is important
to immune function and influences metabolic risk factors
such as obesity and glycaemic control, as well as recovery
from acute illnesses. Poor nutritional status is associated
with worse outcomes in ARDS and viral infections, yet
limited research has assessed pre-morbid nutritional
status and outcomes in patients critically unwell with
Objectives Investigate the effect of body mass index
(BMI), glycaemic control and vitamin D status on outcomes
in adult patients with COVID-19 admitted to an intensive
care unit (ICU).
Methods Retrospective review of all patients admitted
to a central London ICU between March and May 2020
with confirmed COVID-19. Electronic patient records data
were analysed for patient demographics; comorbidities;
admission BMI; and serum vitamin D, zinc, selenium
and haemoglobin A1c (HbA1c) concentrations. Serum
vitamin D and HbA1c were measured on admission, or
within 1 month of admission to ICU. Primary outcome of
interest was mortality. Secondary outcomes included time
intubated, ICU stay duration and ICU-related morbidity.
Results Seventy-two patients; 54 (75%) men, mean
age 57.1 (±9.8) years, were included. Overall, mortality
was 24 (33%). No significant association with mortality
was observed across BMI categories. In the survival arm
admission, HbA1c (mmol/mol) was lower, 50.2 vs 60.8,
but this was not statistically significant. Vitamin D status
did not significantly associate with mortality (p=0.131).
However, 32% of patients with low vitamin D (<25 IU/L)
died, compared with 13% of patients with vitamin D levels
>26 IU/L. Serum zinc and selenium, and vitamin B12 and
folate levels were measured in 46% and 26% of patients,
Discussion/conclusion Increased adiposity and
deranged glucose homeostasis may potentially increase
risk of COVID-19 infection and severity, possibly relating
to impaired lung and metabolic function, increased
proinflammatory and prothrombotic mechanisms. Vitamin
What this paper adds
►► This snapshot audit in a London ICU from the first
peak of the COVID-19 pandemic adds to the body
of evidence associating..
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