Evaluation of Nutritional Practices in the Critical Care patient (The ENPIC study): Does nutrition really affect ICU mortality?
2022
Servia-Goixart, Lluís | Lopez-Delgado, Juan C. | Grau-Carmona, Teodoro | Trujillano-Cabello, Javier | Bordeje-Laguna, M Luisa | Mor-Marco, Esther | Portugal-Rodriguez, Esther | Lorencio-Cardenas, Carol | Montejo-Gonzalez, Juan C. | Vera-Artazcoz, Paula | Macaya-Redin, Laura | Martinez-Carmona, Juan Francisco | Iglesias-Rodriguez, Rayden | Monge-Donaire, Diana | Flordelis-Lasierra, José L. | Llorente-Ruiz, Beatriz | Menor-Fernández, Eva M. | Martínez de Lagrán, Itziar | Yebenes-Reyes, Juan C. | Servia-Goixart, Lluís | Trujillano-Cabello, Javier | Escobar-Ortiz, Joan | Montserrat-Ortiz, Neus | Zapata-Rojas, Amalia | Grau-Carmona, Teodoro | Bautista-Redondo, Iris | Cruz-Ramos, Ana | Diaz-Castellanos, Laura | Morales-Cifuentes, Miriam | Bono, Montserrat Plaza- | Montejo-Gonzalez, Juan Carlos | Temprano-Vazquez, Susana | Arjona-Diaz, Veronica | Garcia-Fuentes, Carlos | Mudarra-Reche, Carolina | Orejana-Martin, Maria | Lopez-Delgado, Juan Carlos | Lores-Obradors, Africa | Anguela-Calvet, Laura | Muñoz-Del Río, Gloria | Revelo-Esquibel, Pamela Alejandra | Alanez-Saavedra, Henry | Serra-Paya, Pau | Luna-Solis, Stephani Maria | Salinas-Canovas, Alvaro | De Frutos-Seminario, Fernando | Rodriguez-Queralto, Oriol | Gonzalez-Iglesias, Carlos | Zamora-Elson, Monica | Fuente-O'Connor, Eugenia de la | Arbeloa, Carlos Seron- | Bueno-Vidales, Nestor | Iglesias-Rodriguez, Rayden | Martin-Luengo, Ana | Sanchez-Miralles, Angel | Marmol-Peis, Enrique | Ruiz-Miralles, Miriam | Gonzalez-Sanz, Maria | Server-Martinez, Arantzazu | Vila-Garcia, Belen | Lorencio-Cardenas, Carol | Macaya-Redin, Laura | Flecha-Viguera, Raquel | Aldunate-Calvo, Sara | Flordelis-Lasierra, Jose Luis | Rio, Irene Jimenez-del | Mampaso-Recio, Jose Ramon | Rodriguez-Roldan, Jose Manuel | Gastaldo-Simeon, Rosa | Gimenez-Castellanos, Josefina | Fernandez-Ortega, Juan Francisco | Martinez-Carmona, Juan F. | Lopez-Luque, Esther | Ortega-Ordiales, Ane | Crespo-Gomez, Monica | Ramirez-Montero, Victor | Lopez-García, Esther | Navarro-Lacalle, Arturo | Martinez-Garcia, Pilar | Dominguez-Fernandez, Maria Inmaculada | Vera-Artazcoz, Paula | Izura-Gomez, Marta | Hernandez-Duran, Susana | Bordeje-Laguna, Ma Luisa | Mor-Marco, Esther | Rovira-Valles, Yaiza | Philibert, Viridiana | Alcazar-Espin, Maravillas de las Nieves | Higon-Cañigral, Aurea | Calvo-Herranz, Enrique | Manzano-Moratinos, Diego | Portugal-Rodriguez, Esther | Andaluz-Ojeda, David | Parra-Morais, Laura | Citores-Gonzalez, Rafael | Garcia-Gonzalez, Maria Teresa | Sanchez-Giron, Gloria Renedo | Navas-Moya, Elisabeth | Ferrer-Pereto, Carles | Lluch-Candal, Cristina | Ruiz-Izquierdo, Jessica | Castor-Bekari, Silvia | Leon-Cinto, Cristina | Martinez de Lagran, Itziar | Yebenes-Reyes, Juan Carlos | Nieto-Martino, Beatriz | Vaquerizo-Alonso, Clara | Almanza-Lopez, Susana | Perez-Quesada, Sonia | Anton-Pascual, Jose Luis | Marin-Corral, Judith | Sistachs-Baquedano, Maite | Hacer-Puig, Maria | Picornell-Noguera, Marina | Mateu-Campos, Lidon | Martinez-Valero, Clara | Ortiz-Suñer, Andrea | Llorente-Ruiz, Beatriz | Martinez-Diaz, María Cristina | Muñoz De La Peña, Maria Trascasa- | Rodriguez-Serrano, Diego Anibal | Fernández Salvatierra, Leticia | Barcelo-Castello, Mireia | Millan-Taratiel, Paula | Tejada-Artigas, Antonio | Martinez-Arroyo, Ines | Araujo-Aguilar, Pilar | Fuster-Cabre, Maria | Andres-Gines, Laura | Soldado-Olmo, Sonia | Menor-Fernandez, Eva Mª | Lage-Cendon, Lucas | Touceda-Bravo, Alberto | Sanchez-Ales, Laura | Almorin-Gonzalvez, Laura | Gero-Escapa, Maria | Martinez-Barrio, Esther | Ossa-Echeverri, Sergio | Monge-Donaire, Diana
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. 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. 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). 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. ClinicaTrials.gov NCT: 03634943.
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