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Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective
Emmanuel Pardo1, Thomas Lescot2, Jean-Charles Preiser3
1Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance publique-hôpitaux de Paris, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France. emmanuel.pardo@aphp.fr.
Insights
Early nutrition support in intensive care units (ICUs) was linked to higher day 28 mortality, especially in younger, less ill patients. This challenges current guidelines for ICU nutrition practices.
Area of Science:
- Critical Care Medicine
- Nutritional Support
- Clinical Research
Background:
- Current intensive care unit (ICU) guidelines recommend early nutrition support within 48 hours for non-oral feeding patients.
- Practices regarding early nutrition support in ICUs require detailed description and analysis.
Purpose of the Study:
- To describe nutrition practices in intensive care units (ICUs).
- To investigate the association between early nutrition support (within 48 hours) and 28-day (D28) mortality in ICU patients.
Main Methods:
- A multicentre prospective cohort study ('French-Speaking ICU Nutritional Survey' - FRANS) involving 26 ICUs.
- Inclusion of adult patients with an expected ICU stay >3 days, followed for 10 days, with D28 mortality assessed.
- Univariate and multivariate propensity-score-weighted logistic regression analyses were used to examine the association between early nutrition and mortality.
Main Results:
- 1206 patients were included; 59.5% received early nutrition support (enteral: 504, parenteral: 214).
- Early nutrition was associated with increased D28 mortality (adjusted OR 1.05, 95% CI 1.00-1.10), particularly in younger patients (≤65 years) with lower SOFA scores (≤8).
- Early enteral nutrition showed a significant association with increased D28 mortality (aOR 1.06, 95% CI 1.01-1.11), unlike early parenteral nutrition.
Conclusions:
- Early nutrition support in the ICU was significantly associated with increased 28-day mortality.
- The association was more pronounced in younger, less severely ill patients.
- Findings contrast with current guidelines and may necessitate re-evaluation of early nutrition practices, especially for low-risk patients.
Background:
Current guidelines suggest the introduction of early nutrition support within the first 48 h of admission to the intensive care unit (ICU) for patients who cannot eat. In that context, we aimed to describe nutrition practices in the ICU and study the association between the introduction of early nutrition support (< 48 h) in the ICU and patient mortality at day 28 (D28) using data from a multicentre prospective cohort.
Methods:
The 'French-Speaking ICU Nutritional Survey' (FRANS) study was conducted in 26 ICUs in France and Belgium over 3 months in 2015. Adult patients with a predicted ICU length of stay > 3 days were consecutively included and followed for 10 days. Their mortality was assessed at D28. We investigated the association between early nutrition (< 48 h) and mortality at D28 using univariate and multivariate propensity-score-weighted logistic regression analyses.
Results:
During the study period, 1206 patients were included. Early nutrition support was administered to 718 patients (59.5%), with 504 patients receiving enteral nutrition and 214 parenteral nutrition. Early nutrition was more frequently prescribed in the presence of multiple organ failure and less frequently in overweight and obese patients. Early nutrition was significantly associated with D28 mortality in the univariate analysis (crude odds ratio (OR) 1.69, 95% confidence interval (CI) 1.23-2.34) and propensity-weighted multivariate analysis (adjusted OR (aOR) 1.05, 95% CI 1.00-1.10). In subgroup analyses, this association was stronger in patients ≤ 65 years and with SOFA scores ≤ 8. Compared with no early nutrition, a significant association was found of D28 mortality with early enteral (aOR 1.06, 95% CI 1.01-1.11) but not early parenteral nutrition (aOR 1.04, 95% CI 0.98-1.11).
Conclusions:
In this prospective cohort study, early nutrition support in the ICU was significantly associated with increased mortality at D28, particularly in younger patients with less severe disease. Compared to no early nutrition, only early enteral nutrition appeared to be associated with increased mortality. Such findings are in contrast with current guidelines on the provision of early nutrition support in the ICU and may challenge our current practices, particularly concerning patients at low nutrition risk. Trial registration ClinicalTrials.gov Identifier: NCT02599948. Retrospectively registered on November 5th 2015.
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