Feeding time index and mortality in intensive care stroke patients: an exploratory cohort study

Stroke is a major cause of morbidity and mortality worldwide, with especially high mortality in intensive care unit (ICU) patients, whose prognosis is worsened by dysphagia, malnutrition, and aspiration risk. The Feeding Time Index (FTI)-defined as the ratio of feeding days to total ICU length of stay-quantified nutritional exposure. This exploratory cohort study aimed to evaluate the association between FTI and mortality in ICU patients with acute ischemic stroke (IS) or hemorrhagic stroke (HS) and to examine the potential role of FTI, together with the Acute Physiology and Chronic Health Evaluation II (APACHE II) score and oral feeding status, as a supportive metric for quantitative assessment of nutritional practices.

In this retrospective observational study, 239 stroke patients admitted to the ICU were analyzed. Demographic data, clinical characteristics, APACHE II scores, time to feeding initiation, feeding routes, and FTI values were collected. Univariate and multivariate Cox regression analyses were performed to identify independent predictors of mortality.

Among 239 ICU patients, 56.9% had IS and 43.1% had HS, with an ICU mortality rate of 31%. Higher FTI values were significantly associated with a lower mortality risk in univariate Cox analysis (hazard ratio (HR) = 0.06), but this association was not maintained in the multivariate model. In contrast, inability to feed orally (HR = 14.8) and higher APACHE II scores (HR = 1.07) remained the main independent predictors of mortality.

These findings suggest that, while FTI is a useful complementary and exploratory indicator of the relationship between feeding duration and clinical outcomes in ICU stroke patients, mortality prediction relies more heavily on clinical factors such as the APACHE II score and oral feeding status. Thus, FTI should be viewed as a supportive metric for quantitatively monitoring nutritional practices, and further multicenter prospective studies controlling more thoroughly for disease severity are needed to clarify its prognostic value and role in guiding nutritional strategies.