Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study

Critical Care

Research

Priscilla Boizeau¹  Garry Taverny¹  Corinne Alberti¹  Samir Jaber²  Pablo Massanet³  Fabienne Tamion⁴  Vincent Fraipont⁵  Laurent Petit⁶  Jean-Charles Preiser⁷  Eric Levesque⁸  Marie-Pierre Bonnet⁹  Jean-Michel Constantin^1,10  Antoine Pons^1,10  Emmanuel Pardo^1,11  Thomas Lescot^1,11  Carole Ichai^1,12 

[1] AP-HP, Hôpital Robert-Debré, Unité d’Epidémiologie Clinique, 48 bd Serurier, 75019, Paris, France;Department of Anaesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier. PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier Cedex 5, France;Département Anesthésie-Réanimation, Centre Hospitalier Universitaire Nîmes, 30000, Nîmes, France;Service de Médecine Intensive Réanimation, CHU Rouen, Université de Normandie, UNIROUEN, INSERM U1096, 76000, Rouen, France;Service de Soins Intensifs, Centre Hospitalier Régional de Liège, 4000, Liège, Citadelle, Belgium;Service de réanimation chirurgicale et traumatologique Pellegrin place Amélie Raba-Léon, 33000, Bordeaux, France;Service des Soins intensifs, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium;Service d’anesthésie-réanimation chirurgicale, GHU Henri-Mondor, 94000, Créteil, France;Sorbonne Université, Département Anesthésie-Réanimation, Hôpital Armand Trousseau, DMU DREAM, GRC 29, AP-HP, Paris, France;Université Paris Cité, INSERM, INRA, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Maternité Port Royal, 53 avenue de l’Observatoire, 75014, Paris, France;Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d’Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris, 75013, Paris, France;Sorbonne 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;Université Côte d’Azur, Centre Hospitalier Universitaire de Nice, Département Anesthésie-Réanimation, Nice, France;

关键词: Clinical nutrition;    Intensive care unit;    Enteral nutrition;    Parenteral nutrition;    Critical illness;    Clinical nutrition guidelines;    Mortality;    Early nutrition support;   

DOI  :  10.1186/s13054-022-04298-1

 received in 2022-11-09, accepted in 2022-12-28,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundCurrent 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.MethodsThe ‘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.ResultsDuring 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).ConclusionsIn 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.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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