Efficacy evaluation of medium-chain triglycerides supplementation on acute severe encephalopathy.

Background: This study assessed whether dietary medium-chain triglyceride (MCT) supplementation improves outcomes in acute severe encephalopathy patients within a Neurological Intensive Care Unit (NICU).

Methods: A single-center, double-blind, randomized trial was conducted at The Third Affiliated Hospital of Sun Yat-sen University (May 2021 - August 2023). Forty-six patients were randomized to MCT supplementation (n = 23) or control (n = 23). Primary outcomes were 180-day poor neurologic outcome (modified Rankin Scale score >4) and all-cause mortality. Secondary outcomes included coma duration, mechanical ventilation duration, ICU length of stay, and hospital costs. Final follow-up was May 1, 2024.

Results: At 180 days, poor neurologic outcome occurred in 26.1% (6/23) of the MCT group versus 56.5% (13/23) of controls (RR 0.27; 95% CI 0.08-0.94; P < 0.05). All-cause mortality was 13.0% (MCT) vs. 30.4% (control) (RR 0.43; 95% CI 0.13-1.46; P > 0.05). The MCT group showed significant improvements in all secondary outcomes: shorter coma duration (8.4 vs 13.2 days; P < 0.05), reduced mechanical ventilation (55.0 vs 154.9 h; P < 0.05), shorter ICU stay (13.4 vs 19.3 days; P < 0.05), and lower hospital costs (¥76,000 vs ¥100,200; P < 0.05).

Conclusions: MCT supplementation significantly reduced poor neurologic outcomes at 180 days in acute severe encephalopathy patients. It also significantly shortened coma duration, mechanical ventilation time, ICU stay, and lowered hospital costs. Mortality reduction was not statistically significant.