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

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2022-01-21Author
López Delgado, Juan Carlos
Grau Carmona, Teodoro
Bordeje Laguna, Mª Luisa
Mor Marco, Esther
Portugal Rodríguez, Esther
Lorencio Cardenas, Carol
Montejo González, Juan Carlos
Vera Artazcoz, Paula
Macaya Redin, Laura
Martinez Carmona, Juan Francisco JF,
Iglesias Rodríguez, Rayden
Monge Donaire, Diana
Flordelis Lasierra, Jose Luis
Llorente Ruiz, Beatriz
Menor Fernandez, Eva M.
Martínez de Lagran, Itziar
Yebenes-Reyes, Juan C.
Suggested citation
Servià Goixart, Lluís;
López Delgado, Juan Carlos;
Grau Carmona, Teodoro;
Trujillano Cabello, Javier;
Bordeje Laguna, Mª Luisa;
Mor Marco, Esther;
...
Yebenes-Reyes, Juan C..
(2022)
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Evaluation of Nutritional Practices in the Critical Care patient (The ENPIC study): Does nutrition really affect ICU mortality?.
Clinical nutrition ESPEN, 2022, vol. 47, p. 325-332.
https://doi.org/10.1016/j.clnesp.2021.11.018.
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Background & aims The 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. Methods This 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. Results We 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). Conclusions Old 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.
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