Critically ill COVID-19 patients in northeast Brazil: mortality predictors during the first and second waves including SAPS 3.

BACKGROUND: The Simplified Acute Physiology Score (SAPS) 3 is a reliable score to predict mortality. This study aims to investigate the predictive values of SAPS 3 and other clinical parameters for death in critically ill coronavirus disease 2019 (COVID-19) patients. METHODS: This is a prospective study in a tertiary hospital for patients who required intensive care due to COVID-19 infection in northeast Brazil. Two distinct groups were constructed according to the epidemiological data: first wave and second wave. The severity of patients admitted was estimated using the SAPS 3 score. RESULTS: A total of 767 patients were included: 290 were enrolled in the first wave and 477 in the second wave. Patients in the first wave had more comorbidities, were put on mechanical ventilation and required dialysis and vasopressors more frequently (p<0.05). During the second wave, non-invasive ventilation was more often required (p<0.05). In both periods, older patients and higher SAPS 3 scores on admission were associated with death (p<0.05). Non-invasive ventilation use showed a negative association with death only in the second wave period. In the first wave, the SAPS 3 score was more useful (area under the curve [AUC] 0.897) in predicting death in critically ill COVID-19 patients than in the second wave (AUC 0.810). CONCLUSION: The SAPS 3 showed very reliable predictive values for death during the waves of the COVID-19 pandemic, mostly together with kidney and pulmonary dysfunction.

Enteral nutritional support for patients hospitalized with COVID-19: Results from the first wave in a public hospital.

OBJECTIVES: Nutrition has become an important component in treating individuals during the coronavirus disease of 2019 (COVID-19) pandemic, which is increasingly affecting the world population and causing a collapse in health services. Prolonged hospitalization, including immobilization and catabolism, induces a decrease in body weight and muscle mass that may result in sarcopenia, a condition that impairs respiratory and cardiac function and worsens the prognosis. The present study aimed to analyze enteral nutritional support and the clinical evolution of patients admitted with COVID-19 in Brazil. METHODS: This was a retrospective study, conducted from March to May 2020, of patients admitted to a referral hospital in cardiology and pulmonology in Fortaleza-Ce/Brazil. Two hundred patients infected with COVID-19 were selected for the study. Sociodemographic, clinical, and nutritional data were collected from electronic medical records, and associations between outcomes and the use of the prone body position with nutritional variables were analyzed by linear regression. Odds ratio and 95% confidence interval estimates for the death outcome were analyzed by logistic regression. RESULTS: Of the 112 patients who were fed by enterally, the majority were male (n = 61; 54.5%), elderly (n = 88; 78.6%), and with no current smoking habit (n = 81; 72.3%). The median hospital stay was 14 d, mostly in intensive care units (median: 9 d). Prone body positioning impacted the nutritional therapy. In general, patients who maintained a prone body position tested lower for kcal/kg of body weight, protein/kg of body weight, percentage of diet adequacy, and total caloric value. In addition, patients who died had a lower mean maximum kcal/kg body weight, protein/kg body weight, percentage of diet adequacy, and total caloric value compared with surviving patients. CONCLUSIONS: An association between inadequacies in protein and energy supply with mortality was confirmed, suggesting that nutritional support optimization should be prescribed in such situations.