The relationship between caloric intake and clinical outcomes in critically ill patients: A retrospective study.

IF 2.9 Q3 NUTRITION & DIETETICS
You-Ru Lin, Po-Chuan Chen, Wei-Ting Li, Min-Hsin Huang, Shu-Fen Huang, Chih-Jung Wang, Yu-Wen Chien, Ai-Wen Kao, Yen-Shen Shan
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Abstract

Background & aims: Despite ongoing research, the optimal nutritional support strategy in the first week of intensive care unit (ICU) stay remains unclear, given the complex interplay of the dynamic metabolic change and evolving nutritional requirements. In this study, we assessed the impact of calorie deficiency during this period on the nutritional care of critically ill patients.

Methods: In this retrospective study, we examined ICU admissions from January 2018 to September 2021, focusing on patients whose ICU stay exceeded 7 days. Data were collected from days 2 to 7 of ICU admission. The "average caloric intake (%)" was calculated as the actual calorie intake divided by the calculated calorie requirement over 6 days. Cox proportional hazard models were employed for analyzing the 28-day mortality, supplemented by sensitivity and subgroup analyses.

Results: The analysis of 3,544 patients revealed that those receiving less than 60% of their target calories in the first ICU week experienced higher 28-day mortality (hazard ratio (HR): 1.41, 95% confidence interval (CI): 1.19-1.67, p < 0.0001). Daily caloric intake below 30% of the goal from day 5 onward was associated with a gradual increase in mortality risk. Conversely, a significant reduction in 28-day mortality was noted in patients with a daily intake of >80% starting from day 6.

Conclusion: Our study underscores the correlation between caloric deficit (< 60%) in the initial ICU week and heightened mortality risk. It suggests the potential benefits of aggressive nutritional intervention toward the end of the week. These insights offer valuable guidance for clinicians in critical care settings.

危重病人的热量摄入与临床结果之间的关系:回顾性研究
背景和目的:尽管研究仍在进行,但由于动态代谢变化和营养需求不断变化的复杂相互作用,重症监护病房(ICU)住院第一周的最佳营养支持策略仍不明确。在这项研究中,我们评估了这一时期卡路里缺乏对重症患者营养护理的影响:在这项回顾性研究中,我们检查了 2018 年 1 月至 2021 年 9 月的 ICU 入院情况,重点关注 ICU 住院超过 7 天的患者。数据收集时间为入住 ICU 的第 2 天至第 7 天。平均卡路里摄入量(%)"的计算方法是:实际卡路里摄入量除以计算出的6天卡路里需求量。采用 Cox 比例危险模型分析 28 天死亡率,并辅以敏感性分析和亚组分析:对 3,544 名患者的分析表明,在重症监护室第一周内摄入热量低于目标热量 60% 的患者 28 天死亡率较高(危险比 (HR):1.41,95% 置信区间 (CI):1.19-1.67,P < 0.0001)。从第 5 天开始,每日热量摄入量低于目标值的 30% 会导致死亡风险逐渐增加。相反,从第 6 天开始,每日摄入量大于 80% 的患者 28 天死亡率明显降低:我们的研究强调了 ICU 最初一周热量不足(< 60%)与死亡风险增加之间的相关性。它表明,在一周结束时进行积极的营养干预可能会带来益处。这些见解为重症监护环境中的临床医生提供了宝贵的指导。
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来源期刊
Clinical nutrition ESPEN
Clinical nutrition ESPEN NUTRITION & DIETETICS-
CiteScore
4.90
自引率
3.30%
发文量
512
期刊介绍: Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.
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