Factors associated with the need of parenteral nutrition in critically ill patients after the initiation of enteral nutrition therapy

Despite enteral nutrition (EN) is the preferred route of nutrition in patients with critical illness, EN is not always able to provide optimal nutrient provision and parenteral nutrition (PN) is needed. This is strongly associated with gastrointestinal (GI) complications, a feature of gastrointestin...

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Autores: López-Delgado, Juan Carlos|||0000-0003-3324-1129, Servia Goixart, Luis|||0000-0001-9513-1465, Grau-Carmona, T., Bordeje, Mª Luisa|||0000-0003-4129-7309, Portugal-Rodriguez, E., Lorencio-Cardenas, Carol|||0000-0002-9237-5541, Vera Artazcoz, Paula|||0000-0003-3346-5093, Macaya-Redin, Laura, Martínez Carmona, JF.|||0000-0002-9645-0959, Marin-Corral, Judith|||0000-0003-1320-4427, Flordelis-Lasierra, José Luis, Seron-Arbeloa, C., Alcazar Espin, Maravillas de las Nieves|||0000-0002-4046-1077, Navas-Moya, Elisabeth, Aldunate Calvo, Sara, Nieto Martino, B., Martinez de Lagrán, Itziar|||0000-0002-4593-7417
Tipo de recurso: artículo
Fecha de publicación:2023
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:301119
Acceso en línea:https://ddd.uab.cat/record/301119
https://dx.doi.org/urn:doi:10.3389/fnut.2023.1250305
Access Level:acceso abierto
Palabra clave:Enteral nutrition
Gastrointestinal dysfunction
Intensive care unit
Nutrition therapy
Parenteral nutrition
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spelling Factors associated with the need of parenteral nutrition in critically ill patients after the initiation of enteral nutrition therapyLópez-Delgado, Juan Carlos|||0000-0003-3324-1129Servia Goixart, Luis|||0000-0001-9513-1465Grau-Carmona, T.Bordeje, Mª Luisa|||0000-0003-4129-7309Portugal-Rodriguez, E.Lorencio-Cardenas, Carol|||0000-0002-9237-5541Vera Artazcoz, Paula|||0000-0003-3346-5093Macaya-Redin, LauraMartínez Carmona, JF.|||0000-0002-9645-0959Marin-Corral, Judith|||0000-0003-1320-4427Flordelis-Lasierra, José LuisSeron-Arbeloa, C.Alcazar Espin, Maravillas de las Nieves|||0000-0002-4046-1077Navas-Moya, ElisabethAldunate Calvo, SaraNieto Martino, B.Martinez de Lagrán, Itziar|||0000-0002-4593-7417Enteral nutritionGastrointestinal dysfunctionIntensive care unitNutrition therapyParenteral nutritionDespite enteral nutrition (EN) is the preferred route of nutrition in patients with critical illness, EN is not always able to provide optimal nutrient provision and parenteral nutrition (PN) is needed. This is strongly associated with gastrointestinal (GI) complications, a feature of gastrointestinal dysfunction and disease severity. The aim of the present study was to investigate factors associated with the need of PN after start of EN, together with the use and complications associated with EN. Methods: Adult patients admitted to 38 Spanish intensive care units (ICUs) between April and July 2018, who needed EN therapy were included in a prospective observational study. The characteristics of EN-treated patients and those who required PN after start EN were analyzed (i.e., clinical, laboratory and scores). Results: Of a total of 443 patients, 43 (9.7%) received PN. One-third (29.3%) of patients presented GI complications, which were more frequent among those needing PN (26% vs. 60%, p = 0.001). No differences regarding mean energy and protein delivery were found between patients treated only with EN (n = 400) and those needing supplementary or total PN (n = 43). Abnormalities in lipid profile, blood proteins, and inflammatory markers, such as C-Reactive Protein, were shown in those patients needing PN. Sequential Organ Failure Assessment (SOFA) on ICU admission (Hazard ratio [HR]:1.161, 95% confidence interval [CI]:1.053-1.281, p = 0.003) and modified Nutrition Risk in Critically Ill (mNUTRIC) score (HR:1.311, 95% CI:1.098-1.565, p = 0.003) were higher among those who needed PN. In the multivariate analysis, higher SOFA score (HR:1.221, 95% CI:1.057-1.410, p = 0.007) and higher triglyceride levels on ICU admission (HR:1.004, 95% CI:1.001-1.007, p = 0.003) were associated with an increased risk for the need of PN, whereas higher albumin levels on ICU admission (HR:0.424, 95% CI:0.210-0.687, p = 0.016) was associated with lower need of PN. A higher SOFA and nutrition-related laboratory parameters on ICU admission may be associated with the need of PN after starting EN therapy. This may be related with a higher occurrence of GI complications, a feature of GI dysfunction. Clinical trial registration: ClinicalTrials.gov: NCT03634943.Universitat Autònoma de Barcelona 22023-01-0120232023-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/301119https://dx.doi.org/urn:doi:10.3389/fnut.2023.1250305reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:3011192026-06-06T12:50:31Z
dc.title.none.fl_str_mv Factors associated with the need of parenteral nutrition in critically ill patients after the initiation of enteral nutrition therapy
title Factors associated with the need of parenteral nutrition in critically ill patients after the initiation of enteral nutrition therapy
spellingShingle Factors associated with the need of parenteral nutrition in critically ill patients after the initiation of enteral nutrition therapy
López-Delgado, Juan Carlos|||0000-0003-3324-1129
Enteral nutrition
Gastrointestinal dysfunction
Intensive care unit
Nutrition therapy
Parenteral nutrition
title_short Factors associated with the need of parenteral nutrition in critically ill patients after the initiation of enteral nutrition therapy
title_full Factors associated with the need of parenteral nutrition in critically ill patients after the initiation of enteral nutrition therapy
title_fullStr Factors associated with the need of parenteral nutrition in critically ill patients after the initiation of enteral nutrition therapy
title_full_unstemmed Factors associated with the need of parenteral nutrition in critically ill patients after the initiation of enteral nutrition therapy
title_sort Factors associated with the need of parenteral nutrition in critically ill patients after the initiation of enteral nutrition therapy
dc.creator.none.fl_str_mv López-Delgado, Juan Carlos|||0000-0003-3324-1129
Servia Goixart, Luis|||0000-0001-9513-1465
Grau-Carmona, T.
Bordeje, Mª Luisa|||0000-0003-4129-7309
Portugal-Rodriguez, E.
Lorencio-Cardenas, Carol|||0000-0002-9237-5541
Vera Artazcoz, Paula|||0000-0003-3346-5093
Macaya-Redin, Laura
Martínez Carmona, JF.|||0000-0002-9645-0959
Marin-Corral, Judith|||0000-0003-1320-4427
Flordelis-Lasierra, José Luis
Seron-Arbeloa, C.
Alcazar Espin, Maravillas de las Nieves|||0000-0002-4046-1077
Navas-Moya, Elisabeth
Aldunate Calvo, Sara
Nieto Martino, B.
Martinez de Lagrán, Itziar|||0000-0002-4593-7417
author López-Delgado, Juan Carlos|||0000-0003-3324-1129
author_facet López-Delgado, Juan Carlos|||0000-0003-3324-1129
Servia Goixart, Luis|||0000-0001-9513-1465
Grau-Carmona, T.
Bordeje, Mª Luisa|||0000-0003-4129-7309
Portugal-Rodriguez, E.
Lorencio-Cardenas, Carol|||0000-0002-9237-5541
Vera Artazcoz, Paula|||0000-0003-3346-5093
Macaya-Redin, Laura
Martínez Carmona, JF.|||0000-0002-9645-0959
Marin-Corral, Judith|||0000-0003-1320-4427
Flordelis-Lasierra, José Luis
Seron-Arbeloa, C.
Alcazar Espin, Maravillas de las Nieves|||0000-0002-4046-1077
Navas-Moya, Elisabeth
Aldunate Calvo, Sara
Nieto Martino, B.
Martinez de Lagrán, Itziar|||0000-0002-4593-7417
author_role author
author2 Servia Goixart, Luis|||0000-0001-9513-1465
Grau-Carmona, T.
Bordeje, Mª Luisa|||0000-0003-4129-7309
Portugal-Rodriguez, E.
Lorencio-Cardenas, Carol|||0000-0002-9237-5541
Vera Artazcoz, Paula|||0000-0003-3346-5093
Macaya-Redin, Laura
Martínez Carmona, JF.|||0000-0002-9645-0959
Marin-Corral, Judith|||0000-0003-1320-4427
Flordelis-Lasierra, José Luis
Seron-Arbeloa, C.
Alcazar Espin, Maravillas de las Nieves|||0000-0002-4046-1077
Navas-Moya, Elisabeth
Aldunate Calvo, Sara
Nieto Martino, B.
Martinez de Lagrán, Itziar|||0000-0002-4593-7417
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universitat Autònoma de Barcelona
dc.subject.none.fl_str_mv Enteral nutrition
Gastrointestinal dysfunction
Intensive care unit
Nutrition therapy
Parenteral nutrition
topic Enteral nutrition
Gastrointestinal dysfunction
Intensive care unit
Nutrition therapy
Parenteral nutrition
description Despite enteral nutrition (EN) is the preferred route of nutrition in patients with critical illness, EN is not always able to provide optimal nutrient provision and parenteral nutrition (PN) is needed. This is strongly associated with gastrointestinal (GI) complications, a feature of gastrointestinal dysfunction and disease severity. The aim of the present study was to investigate factors associated with the need of PN after start of EN, together with the use and complications associated with EN. Methods: Adult patients admitted to 38 Spanish intensive care units (ICUs) between April and July 2018, who needed EN therapy were included in a prospective observational study. The characteristics of EN-treated patients and those who required PN after start EN were analyzed (i.e., clinical, laboratory and scores). Results: Of a total of 443 patients, 43 (9.7%) received PN. One-third (29.3%) of patients presented GI complications, which were more frequent among those needing PN (26% vs. 60%, p = 0.001). No differences regarding mean energy and protein delivery were found between patients treated only with EN (n = 400) and those needing supplementary or total PN (n = 43). Abnormalities in lipid profile, blood proteins, and inflammatory markers, such as C-Reactive Protein, were shown in those patients needing PN. Sequential Organ Failure Assessment (SOFA) on ICU admission (Hazard ratio [HR]:1.161, 95% confidence interval [CI]:1.053-1.281, p = 0.003) and modified Nutrition Risk in Critically Ill (mNUTRIC) score (HR:1.311, 95% CI:1.098-1.565, p = 0.003) were higher among those who needed PN. In the multivariate analysis, higher SOFA score (HR:1.221, 95% CI:1.057-1.410, p = 0.007) and higher triglyceride levels on ICU admission (HR:1.004, 95% CI:1.001-1.007, p = 0.003) were associated with an increased risk for the need of PN, whereas higher albumin levels on ICU admission (HR:0.424, 95% CI:0.210-0.687, p = 0.016) was associated with lower need of PN. A higher SOFA and nutrition-related laboratory parameters on ICU admission may be associated with the need of PN after starting EN therapy. This may be related with a higher occurrence of GI complications, a feature of GI dysfunction. Clinical trial registration: ClinicalTrials.gov: NCT03634943.
publishDate 2023
dc.date.none.fl_str_mv 2
2023-01-01
2023
2023-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/301119
https://dx.doi.org/urn:doi:10.3389/fnut.2023.1250305
url https://ddd.uab.cat/record/301119
https://dx.doi.org/urn:doi:10.3389/fnut.2023.1250305
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
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