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Evaluation of Nutritional Practices in the Critical Care patient (The ENPIC study): Does nutrition really affect ICU mortality?

2021; Elsevier BV; Volume: 47; Linguagem: Inglês

10.1016/j.clnesp.2021.11.018

2405-4577

Luis Serviá, Juan Carlos Lopez‐Delgado, T. Grau Carmona, Javier Trujillano, M.L. Bordejé Laguna, Esther Mor-Marco, Esther Portugal-Rodríguez, C. Lorencio, Juan Carlos Montejo, Paula Vera, Laura Macaya-Redin, Juan Francisco Martínez-Carmona, Rayden Iglesias-Rodriguez, Diana Monge-Donaire, José Luis Flordelís Lasierra, Beatriz Llorente-Ruiz, Eva María Menor Fernández, I. Martínez de Lagrán Zurbano, Juan Carlos Yébenes, Luis Serviá, Javier Trujillano, Joan Escobar-Ortiz, Neus Montserrat-Ortiz, Amalia Zapata-Rojas, T. Grau Carmona, Iris Bautista-Redondo, Ana Cruz-Ramos, Laura Diaz-Castellanos, Miriam Morales-Cifuentes, Montserrat Plaza- Bono, Juan Carlos Montejo, Susana Temprano-Vazquez, Veronica Arjona-Diaz, Carlos García-Fuentes, C. Mudarra-Reche, Maria Orejana-Martin, Juan Carlos Lopez‐Delgado, África Lores-Obradors, Laura Anguela-Calvet, Gloria Muñoz-del Rio, Pamela Alejandra Revelo-Esquibel, Henry Alanez-Saavedra, Pau Serra-Paya, Stephani Maria Luna-Solis, Alvaro Salinas-Canovas, Fernando De Frutos-Seminario, Oriol Rodríguez-Queraltó, Carlos Gonzalez-Iglesias, Monica Zamora-Elson, Eugenia de la Fuente-O'Connor, C. Serón Arbeloa, Néstor Bueno-Vidales, Rayden Iglesias-Rodriguez, Ana Isabel Martín-Luengo, Ángel Sánchez-Miralles, Enrique Mármol-Peis, M. Ruiz-Miralles, Maria Gonzalez-Sanz, Arantzazu Server-Martinez, Belen Vila-García, Carol Lorencio-Cardenas, Laura Macaya-Redin, Raquel Flecha-Viguera, S. Aldunate-Calvo, José Luis Flordelís Lasierra, Irene Jimenez-del Rio, Jose Ramon Mampaso-Recio, Jose Manuel Rodriguez-Roldan, Rosa Gastaldo-Simeón, Josefina Gimenez-Castellanos, J.F. Fernández-Ortega, Juan Francisco Martínez-Carmona, Esther Lopez-Luque, Ane Ortega-Ordiales, Monica Crespo-Gomez, Victor Ramirez-Montero, Esther López‐García, Arturo Navarro-Lacalle, Pilar Martínez-García, Maria Inmaculada Dominguez-Fernandez, Paula Vera, Marta Izura-Gómez, Susana Hernandez-Duran, M.L. Bordejé Laguna, Esther Mor-Marco, Yaiza Rovira-Valles, Viridiana Philibert, Maravillas de las Nieves Alcazar-Espin, Aurea Higon-Cañigral, Enrique Calvo-Herranz, Diego Manzano-Moratinos, Esther Portugal-Rodríguez, David Andaluz‐Ojeda, Laura Parra-Morais, R. Cítores-Gónzalez, María Teresa García-González, Gloria Renedo Sánchez‐Girón, Elisabeth Navas-Moya, Carles Ferrer-Pereto, C. Lluch-Candal, Jessica Ruiz-Izquierdo, Silvia Castor-Bekari, Cristina Leon-Cinto, I. Martínez de Lagrán Zurbano, Juan Carlos Yébenes, Beatriz Nieto-Martino, C. Vaquerizo Alonso, Susana Almanza-López, Sonia Pérez-Quesada, José Luis Antón-Pascual, Judith Marín‐Corral, Maite Sistachs-Baquedano, Maria Hacer-Puig, Marina Picornell-Noguera, Lidón Mateu‐Campos, Clara Martinez-Valero, Andrea Ortiz-Suñer, Beatriz Llorente-Ruiz, María Cristina Martinez-Diaz, Maria Trascasa- Muñoz De La Peña, Diego Aníbal Rodríguez-Serrano, Leticia Fernandez-Salvatierra, Mireia Barcelo-Castello, Paula Millan-Taratiel, Antonio Tejada-Artigas, Ines Martinez-Arroyo, Pilar Araujo-Aguilar, María Fuster-Cabré, Laura Andres-Gines, Sonia Soldado-Olmo, Eva Ma Menor-Fernandez, Lucas Lage-Cendon, Alberto Touceda-Bravo, Laura Sanchez-Ales, Laura Almorin-Gonzalvez, María Gero-Escapa, Esther Martinez-Barrio, Sergio Ossa‐Echeverri, Diana Monge-Donaire,

Abdominal Surgery and Complications

Background & aimsThe importance of artificial nutritional therapy is underrecognized, typically being considered an adjunctive rather than a primary therapy. We aimed to evaluate the influence of nutritional therapy on mortality in critically ill patients.MethodsThis multicenter prospective observational study included adult patients needing artificial nutritional therapy for >48 h if they stayed in one of 38 participating intensive care units for ≥72 h between April and July 2018. Demographic data, comorbidities, diagnoses, nutritional status and therapy (type and details for ≤14 days), and outcomes were registered in a database. Confounders such as disease severity, patient type (e.g., medical, surgical or trauma), and type and duration of nutritional therapy were also included in a multivariate analysis, and hazard ratios (HRs) and 95% confidence intervals (95%CIs) were reported.ResultsWe included 639 patients among whom 448 (70.1%) and 191 (29.9%) received enteral and parenteral nutrition, respectively. Mortality was 25.6%, with non-survivors having the following characteristics: older age; more comorbidities; higher Sequential Organ Failure Assessment (SOFA) scores (6.6 ± 3.3 vs 8.4 ± 3.7; P < 0.001); greater nutritional risk (Nutrition Risk in the Critically Ill [NUTRIC] score: 3.8 ± 2.1 vs 5.2 ± 1.7; P < 0.001); more vasopressor requirements (70.4% vs 83.5%; P=0.001); and more renal replacement therapy (12.2% vs 23.2%; P=0.001). Multivariate analysis showed that older age (HR: 1.023; 95% CI: 1.008–1.038; P=0.003), higher SOFA score (HR: 1.096; 95% CI: 1.036–1.160; P=0.001), higher NUTRIC score (HR: 1.136; 95% CI: 1.025–1.259; P=0.015), requiring parenteral nutrition after starting enteral nutrition (HR: 2.368; 95% CI: 1.168–4.798; P=0.017), and a higher mean Kcal/Kg/day intake (HR: 1.057; 95% CI: 1.015–1.101; P=0.008) were associated with mortality. By contrast, a higher mean protein intake protected against mortality (HR: 0.507; 95% CI: 0.263–0.977; P=0.042).ConclusionsOld age, higher organ failure scores, and greater nutritional risk appear to be associated with higher mortality. Patients who need parenteral nutrition after starting enteral nutrition may represent a high-risk subgroup for mortality due to illness severity and problems receiving appropriate nutritional therapy. Mean calorie and protein delivery also appeared to influence outcomes.Trial registrationClinicaTrials.gov NCT: 03634943.