Hypermetabolism and Coronavirus Disease 2019

Area of Science:

• Critical care medicine
• Metabolic research
• Infectious diseases

Background:

• Hypermetabolism is a known response to severe physiological stress.
• Conditions like trauma, sepsis, ARDS, and burns induce hypermetabolic states.
• The metabolic profile of Coronavirus disease 2019 (COVID-19) remained largely uncharacterized.

Purpose of the Study:

• To investigate the hypothesis that Coronavirus disease 2019 (COVID-19) induces a hypermetabolic state in critically ill patients.
• To determine if this hypermetabolic state contributes to the high ventilatory and oxygenation demands observed in COVID-19.

Main Methods:

• Indirect calorimetry was employed to measure key metabolic parameters.
• Resting energy expenditure (REE), carbon dioxide production (VCO2), and oxygen consumption (VO2) were assessed.
• Measurements were taken in a cohort of 7 critically ill patients diagnosed with COVID-19.

Main Results:

• Patients exhibited significantly elevated resting energy expenditure (REE), averaging 235.7% of predicted values (median 4044 kcal/d).
• Elevated rates of carbon dioxide production (VCO2) and oxygen consumption (VO2) were observed, with medians of 452 mL/min and 585 mL/min, respectively.
• These findings indicate an extreme hypermetabolic state in the studied COVID-19 patients.

Conclusions:

• Critically ill patients with COVID-19 present with an extreme hypermetabolic state.
• This hypermetabolism may be a significant factor contributing to the high rates of mechanical ventilation failure.
• The findings underscore the potential necessity for increased nutritional support in managing severe COVID-19.