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Published on: June 11, 2012
Association between early 48-hour caloric intake and time in glycemic target range in post-abdominal surgery
Li Wu1, Hui Liao2, Xiaojie Wu1
1Public Health Department, Yongkang First People's Hospital, Zhejiang, China.
Background:
Maintaining glycemic Time in Range (TIR) is a pivotal factor in patient recovery following abdominal surgery. However, the impact of early caloric intake on TIR in postoperative abdominal Intensive Care Unit (ICU) patients unclear.
Methods:
A total of 4871 adults from the MIMIC-IV database (2008-2019) who were admitted to the ICU within 24 h of abdominal surgery were included. Multivariate logistic regression and Restricted Cubic Spline (RCS) were used to quantify the dose-response relationship between early 48-h caloric intake and TIR. In addition, a predictive model was developed, model fit was assessed using the Hosmer-Lemeshow test and calibration curves. Decision-curve analysis was used to quantify the clinical benefit, and a nomograms was constructed for internal validation.
Results:
We found that high caloric (≥5360 kcal) intake in the early 48 h was significantly associated with higher TIR (OR = 1.12, 95%CI:1.01-1.25, P = 0.048). After adjusting for relevant confounders, the association was strengthened (OR = 1.34, 95%CI:1.18-1.62, P = 0.002). The RCS model revealed a significant nonlinear relationship in unadjusted analysis and a linear relationship after adjustment. The predictive model showed that early 48-h high caloric intake had excellent discriminative power for glycemic control (Area Under the Curve (AUC): 0.915). Stratified analyses showed that aged <65 years (OR = 1.25, 95%CI: 1.03-1.51, P = 0.024), female (OR = 1.29, 95%CI:1.04-1.60, P = 0.018), non-hypertensive (OR = 1.27, 95%CI: 1.07-1.52, P = 0.007), non-diabetic (OR = 1.27, 95%CI: 1.08-1.49, P = 0.003), non-Chronic Kidney Disease (CKD) (OR = 1.23, 95%CI: 1.06-1.44, P = 0.007), and non-hepatic failure (OR = 1.25, 95%CI: 1.09-1.44, P = 0.002) patients were most likely to positive association from 48 h caloric intake to gain a glycemic advantage.
Conclusion:
High calorie intake during the first 48 h after abdominal surgery in ICU patients was significantly associated with higher TIR and lower mean blood glucose. The association was greater in adults younger than 65 years, women, and patients without hypertension, diabetes, CKD, or liver failure.
