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oai:recercat.cat:11351/72282025-10-24T10:59:56Zcom_2072_451665com_2072_378040col_2072_451666

Evaluation of Nutritional Practices in the Critical Care patient (The ENPIC study): Does nutrition really affect ICU mortality? Grau, Teodoro Mor-Marco, Esther Iglesias-Rodriguez, Rayden Lopez-Delgado, Juan Carlos Servia Goixart, Luis Trujillano, Javier Bordeje, Mª Luisa [Servia-Goixart L, Trujillano-Cabello J] Hospital Universitari Arnau de Vilanova, Intensive Care Department, Lleida, Spain. IRBLLeida (Institut de Recerca Biomedica de Lleida Fundacio Dr. Pifarré; Lleida Biomedical Research Institute's Dr. Pifarré Foundation, Lleida, Spain. [Lopez-Delgado JC] Hospital Universitari de Bellvitge, Intensive Care Department, Hospitalet de Llobregat, Spain. IDIBELL (Institut d’Investigacio Biomédica Bellvitge; Biomedical Investigation Institute of Bellvitge, Hospitalet de Llobregat, Spain. [Grau-Carmona T] Hospital Universitario 12 de Octubre, Intensive Care Department, Madrid, Spain. i+12 (Instituto de Investigacion Sanitaria Hospital 12 de Octubre; Research Institute Hospital 12 de Octubre), Madrid, Spain. [Bordeje-Laguna ML, Mor-Marco E] Hospital Universitario Germans Trias i Pujol, Intensive Care Department, Badalona, Spain. [Iglesias-Rodriguez R] Hospital General de Granollers, Intensive Care Department, Granollers, Spain Hospital General de Granollers Nutrició enteral Medicina intensiva Mortalitat ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Feeding Methods::Enteral Nutrition HEALTH SURVEILLANCE::Health Surveillance of Health Services::Health Facilities::Hospitals::Hospital Units::Intensive Care Units PUBLIC HEALTH::Epidemiology and Biostatistics::Biostatistics::Information Storage and Retrieval::Mortality Registries TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::métodos de alimentación::nutrición enteral VIGILANCIA SANITARIA::vigilancia sanitaria de los servicios de salud::centros sanitarios::hospitales::unidades hospitalarias::unidades de cuidados intensivos SALUD PÚBLICA::epidemiología y bioestadística::bioestadística::almacenamiento y recuperación de la información::registros de mortalidad Enteral nutrition; Intensive care unit; Mortality Nutrició enteral; Unitat de Cures Intensives; Mortalitat Nutrición enteral; Unidad de Cuidados Intensivos; Mortalidad 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. 2022-03-22T13:12:49Z 2022-03-22T13:12:49Z 2022-02-01 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Servia-Goixart L, Lopez-Delgado JC, Grau-Carmona T, Trujillano-Cabello J, Bordeje-Laguna ML, Mor-Marco E, et al. Evaluation of Nutritional Practices in the Critical Care patient (The ENPIC study): Does nutrition really affect ICU mortality? Clin Nutr ESPEN. 2022 Feb;47:325-332. 2405-4577 https://hdl.handle.net/11351/7228 10.1016/j.clnesp.2021.11.018 35063222 http://hdl.handle.net/11351/7228 eng Clinical nutrition ESPEN;47 https://doi.org/10.1016/j.clnesp.2021.11.018 Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess application/pdf Elsevier Scientia