Relation between nutrition therapy in the acute phase and outcomes of ventilated patients with COVID-19 infection: A multicenter prospective observational study

Kensuke Nakamura, Junji Hatakeyama, Keibun Liu, Naoki Kanda, Kazuma Yamakawa, Takeshi Nishida, Shinichiro Ohshimo, Shigeaki Inoue, Satoru Hashimoto, Shuhei Maruyama, Daisuke Kawakami, Yoshitaka Ogata, Katsura Hayakawa, Hiroaki Shimizu, Taku Oshima, Tatsuya Fuchigami, Osamu Nishida

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: Optimal nutrition therapy has not yet been established for the acute phase of severe coronavirus disease 2019 (COVID-19) infection. Objectives: We aimed to examine the effects of nutrition delivery in the acute phase on mortality and the long-term outcomes of post-intensive care syndrome (PICS). Methods: A multicenter prospective study was conducted on adult patients with COVID-19 infection requiring mechanical ventilation during an intensive care unit (ICU) stay. Daily total energy (kcal/kg) and protein (g/kg) deliveries in the first week of the ICU stay were calculated. The questionnaire for PICS evaluation was mailed within a median of 6 mo after hospital discharge. The primary outcome was in-hospital mortality, and secondary outcomes were the PICS components of physical impairment, cognitive dysfunction, and mental illness. Results: Among 414 eligible patients, 297 who received mechanical ventilation for 7 d or longer were examined. PICS was evaluated in 175 patients among them. High protein delivery on days 4-7 correlated with a low in-hospital mortality rate. In contrast, high protein delivery on days 1-3 correlated with physical impairment. A multivariate logistic regression analysis adjusted for age, sex, BMI, and severity revealed that average energy and protein deliveries on days 4-7 correlated with decreased in-hospital mortality (OR: 0.94; 95% CI: 0.89, 0.99; P = 0.013 and OR: 0.40; 95% CI: 0.17, 0.93; P = 0.031, respectively). Nutrition delivery did not correlate with PICS outcomes after adjustments. In the multivariate regression using a restricted cubic spline model, in-hospital mortality monotonically decreased with increases in average nutrition delivery on days 4-7. Conclusions: In patents with COVID-19 on mechanical ventilation for ≥7 d, nutrition delivery in the late period of the acute phase was monotonically associated with a decrease in in-hospital mortality. Adequate protein delivery is needed on days 4-7. This trial was registered at as UMIN000041276.

Original languageEnglish
Pages (from-to)1115-1122
Number of pages8
JournalAmerican Journal of Clinical Nutrition
Issue number4
Publication statusPublished - 01-04-2022

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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