Effect of Parenteral Nutrition and Albumin in Oxygen Escalation/De-Escalation in SARS-CoV-2 Infected Patients Who are Pre-Intubation: A Multicenter, Observational Study in NYC

Background: SARS-CoV-2 infection includes a variety of gastrointestinal manifestations along with the usual viral symptoms of malaise and myalgias. The objective of this study was to determine if intravenous parenteral nutrition (PN) affected the risk of intubation in SARS-CoV-2 patients who were dependent on CPAP or BiPAP. This was the first study to investigate the role of nutrition in patients with severe SARS-CoV-2 infection. Methods: Retrospective, multicenter case-control study which analyzed oxygen requirements for 1974 adults with SARS-CoV-2, who were admitted to the NYCHHC system between March 1 and May 17, 2020. The exposure of interest was PN. Relevant baseline biomarkers were studied over 5 days. The main outcome was an escalation or de-escalation of oxygen requirements. Findings: 111 patients received PN while on CPAP/BiPAP. In the PN and control groups, there was a significant change between days 0-1 of oxygen requirements, suggesting changes within 24 hours after initiation on CPAP/BiPAP is suggestive for escalation or de-escalation of oxygen requirements. Day 0 albumin level was the only predictive marker for oxygen escalation in both the PN group (p<0.001) and the control group (p<0.001). Interpretation: Initiating PN in the setting of non-invasive ventilation of SARS-CoV-2  infected patients was significantly associated with a decrease in oxygen requirements over the initial 24 hours. Day 0 serum albumin level was predictive for oxygen escalation/de-escalation with marked improvement noted in patients who received PN. PN does not exacerbate oxygen requirements in SARS-CoV-2 infected pre-intubated patients. Funding: NYCHHC Office of Population Health. Conflict of Interest: None to declare. Ethical Approval: The protocol was approved by the Biomedical Research Alliance of New York (BRANY) via the NYCHHC institutional review board and sponsored by NYCHHC’s Office of Population Health.