Early enteral nutrition may reduce the incidence of Refeeding Syndrome for severe COVID-19 patients with high nutritional risks

Abstract

Abstract Background & aims: Nutrition therapy is an inevitable supportive intervention for COVID-19 patients with high nutritional risks. However, the suitable initiation time of nutrition still remains to be explored. The aim of this study is to determine the association between the enteral nutrition initiation and the incidence of refeeding syndrome for severe COVID-19 patients with high nutritional risks. Method: We compared the different initiation times and observed their relationship with the incidence of Refeeding Syndrome (RS). We retrospectively collected data of 124 confirmed severe COVID-19 cases with ≥ 3 scores of Nutrition Risk Screen - 2002 who received Enteral Nutrition (EN) from January 1st to April 30th of 2020 in Tongji Hospital. Based on the initiation time, patients who received EN within two days after admission were classified into the early enteral nutrition (EEN) group, while the others were included in the late enteral nutrition (LEN) group. The serum levels of potassium, phosphorus, and magnesium were measured on the third day after EN to compare the incidence of RS between the two groups. Results: Fifty-four (43.55%) patients were included in the EEN group, while 70 (56.45%) belonged to the LEN group. The mean time interval of EN was one day in EEN and seven days in LEN. The majority of laboratory markers were comparable between the two groups on admission. Three days after EN support, the levels of serum potassium, sodium, phosphorus, and magnesium were significantly lower, and the incidence, as well as the degree of RS, was significantly higher in the LEN group. Conclusion: We conclude that early EN could be a reasonable mode to reduce the incidence of RS in severe COVID-19 patients with high nutritional risks.