Cochrane COVID-19 Study Register
Santulario-Verdu 2020

Hypertriglyceridemia in Sars-Cov-2 infected patients treated with parenteral nutrition

  1. Study Type
  2. Observational
  1. Study Aim
  2. Not applicable
  1. Study Design
  2. Case series/Case control/Cohort
  1. Intervention Assignment
  2. Not Applicable

Hypertriglyceridemia in Sars-Cov-2 infected patients treated with parenteral nutrition

Santulario-Verdu L, Colls-Gonzalez M, Badia-Tahull M, Llop-Talaveron JM, Munoz-Bolano M, Otero-Torres S, Fernandez-Alvarez M, Leiva-Badosa E
Rationale: To evaluate hypertriglyceridemia (HTG) risk factors in adult hospitalized COVID patients treated with Parenteral Nutrition (PN). Methods: Patients starting PN from 03/16-04/15/2020 were selected. Data collected: demographic, nutritional (indication, days of PN, PN composition (g/kg/d by adjusted body weight); COVID treatments and analytical. In our COVID protocol, inflammatory state (IS) was considered with at least 2 of the next criteria: PCR>100mg/L, DD>1.000μ/L, LDH>400U/L, ferritin>1.000ng/ml and IL-6>70ng/L. HTG was defined as triglycerides (TG)≥3 mmol/L. Data expressed as median [IQR]. T-student test to compare our results with a previous no-COVID cohort with PN at our center and TG at PN beginning and end. Multivariate analysis to study TG at PN beginning and HTG risk factors. Results: 54 patients, 72.2% men, 67.6 [13.4] years, 80 [19.3] kg, 29.8 [5.6] kg/m2, 61.1 % had dyslipidaemia. PN lasted 5 [5] days. 83.3% received PN for enteral intolerance. PN composition (g/kg/d): 1.28 [0.05] nitrogen, 0.57 [0.78] lipids, 3.05 [1.53] glucose and 19.8 [7.1] kcal/kg/d. No differences between TGC at PN beginning and ending (3,56 [1.01] vs 3.621[1.74], p: 0.89). 80% met IS, 79.6% critical or semicritical, and 50% died. 81.5% received tocilizumab, 79.6% propofol and 12.9% tacrolimus. TG before PN started were higher than our previous cohort (3.31[1.14] vs 2.24[1.19] mmol/L; p<0.001)and patients received lower lipid dose (0.52 [0.02] and 0.7[0.18] g/kg/d, respectively (p <0.001). Multivariate regression analysis showed a significant relationship between tocilizumab and initial TG (1.459 [0.342-2.576], r2=0.431), while IS, propofol, BMI, dylipidemia, tacrolimus, Lopinavir/r were not significant. Conclusion: COVID patients may have an increased HTG risk, especially those with tocilizumab. However, more studies must be conducted. Despite reducing PN lipid dose, TG reduction was not observed. References: Llop J, Sabin P, Garau M et al. The importance of clinical factors in parenteral nutrition associated hypertriglyceridemia. Clinical Nutrition (2003) 22(6): 577–583 Disclosure of Interest: None declared