Evaluation of Nutritional Practices in the Critical Care Patient (The ENPIC Study): Does Nutrition Really Affect ICU Mortality?
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...
| Autores: | , , , , , , , , , , , , , , , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2021 |
| País: | España |
| Institución: | Universidad de Barcelona |
| Repositorio: | Dipòsit Digital de la UB |
| OAI Identifier: | oai:diposit.ub.edu:2445/183104 |
| Acceso en línea: | https://hdl.handle.net/2445/183104 |
| Access Level: | acceso abierto |
| Palabra clave: | Nutrició Medicina intensiva Nutrition Critical care medicine |
| id |
ES_ba37ea30a21ff5dde69a04469ac7b16f |
|---|---|
| oai_identifier_str |
oai:diposit.ub.edu:2445/183104 |
| network_acronym_str |
ES |
| network_name_str |
España |
| repository_id_str |
|
| spelling |
Evaluation of Nutritional Practices in the Critical Care Patient (The ENPIC Study): Does Nutrition Really Affect ICU Mortality?Servia Goixart, LluísLópez Delgado, Juan CarlosGrau Carmona, TeodoroMartínez de Lagran, ItziarENPIC Study InvestigatorsYebenes Reyes, Juan C.Trujillano Cabello, JavierBordeje Laguna, Maria LuisaMor Marco, EstherMenor Fernández, Eva M.Llorente Ruiz, BeatrizMartinez Carmona, Juan FranciscoVera Artazcoz, PaulaIglesias Rodriguez, RaydenMonge Donaire, DianaFlordelis Lasierra, José L.Portugal Rodriguez, EstherLorencio Cardenas, CarolMontejo Gonzalez, Juan C.Macaya Redin, LauraNutricióMedicina intensivaNutritionCritical care medicineBackground & 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 char-acteristics: 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. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of European Society for Clinical Nutrition and Metabolism.Elsevier BV2021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/183104Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1016/j.clnesp.2021.11.018Clinical Nutrition ESPEN, 2021, vol 47, p. 325-332https://doi.org/10.1016/j.clnesp.2021.11.018cc by-nc-nd (c) Servia Goixart, Lluís et al, 2021http://creativecommons.org/licenses/by-nc-nd/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1831042026-05-27T06:46:51Z |
| dc.title.none.fl_str_mv |
Evaluation of Nutritional Practices in the Critical Care Patient (The ENPIC Study): Does Nutrition Really Affect ICU Mortality? |
| title |
Evaluation of Nutritional Practices in the Critical Care Patient (The ENPIC Study): Does Nutrition Really Affect ICU Mortality? |
| spellingShingle |
Evaluation of Nutritional Practices in the Critical Care Patient (The ENPIC Study): Does Nutrition Really Affect ICU Mortality? Servia Goixart, Lluís Nutrició Medicina intensiva Nutrition Critical care medicine |
| title_short |
Evaluation of Nutritional Practices in the Critical Care Patient (The ENPIC Study): Does Nutrition Really Affect ICU Mortality? |
| title_full |
Evaluation of Nutritional Practices in the Critical Care Patient (The ENPIC Study): Does Nutrition Really Affect ICU Mortality? |
| title_fullStr |
Evaluation of Nutritional Practices in the Critical Care Patient (The ENPIC Study): Does Nutrition Really Affect ICU Mortality? |
| title_full_unstemmed |
Evaluation of Nutritional Practices in the Critical Care Patient (The ENPIC Study): Does Nutrition Really Affect ICU Mortality? |
| title_sort |
Evaluation of Nutritional Practices in the Critical Care Patient (The ENPIC Study): Does Nutrition Really Affect ICU Mortality? |
| dc.creator.none.fl_str_mv |
Servia Goixart, Lluís López Delgado, Juan Carlos Grau Carmona, Teodoro Martínez de Lagran, Itziar ENPIC Study Investigators Yebenes Reyes, Juan C. Trujillano Cabello, Javier Bordeje Laguna, Maria Luisa Mor Marco, Esther Menor Fernández, Eva M. Llorente Ruiz, Beatriz Martinez Carmona, Juan Francisco Vera Artazcoz, Paula Iglesias Rodriguez, Rayden Monge Donaire, Diana Flordelis Lasierra, José L. Portugal Rodriguez, Esther Lorencio Cardenas, Carol Montejo Gonzalez, Juan C. Macaya Redin, Laura |
| author |
Servia Goixart, Lluís |
| author_facet |
Servia Goixart, Lluís López Delgado, Juan Carlos Grau Carmona, Teodoro Martínez de Lagran, Itziar ENPIC Study Investigators Yebenes Reyes, Juan C. Trujillano Cabello, Javier Bordeje Laguna, Maria Luisa Mor Marco, Esther Menor Fernández, Eva M. Llorente Ruiz, Beatriz Martinez Carmona, Juan Francisco Vera Artazcoz, Paula Iglesias Rodriguez, Rayden Monge Donaire, Diana Flordelis Lasierra, José L. Portugal Rodriguez, Esther Lorencio Cardenas, Carol Montejo Gonzalez, Juan C. Macaya Redin, Laura |
| author_role |
author |
| author2 |
López Delgado, Juan Carlos Grau Carmona, Teodoro Martínez de Lagran, Itziar ENPIC Study Investigators Yebenes Reyes, Juan C. Trujillano Cabello, Javier Bordeje Laguna, Maria Luisa Mor Marco, Esther Menor Fernández, Eva M. Llorente Ruiz, Beatriz Martinez Carmona, Juan Francisco Vera Artazcoz, Paula Iglesias Rodriguez, Rayden Monge Donaire, Diana Flordelis Lasierra, José L. Portugal Rodriguez, Esther Lorencio Cardenas, Carol Montejo Gonzalez, Juan C. Macaya Redin, Laura |
| author2_role |
author author author author author author author author author author author author author author author author author author author |
| dc.subject.none.fl_str_mv |
Nutrició Medicina intensiva Nutrition Critical care medicine |
| topic |
Nutrició Medicina intensiva Nutrition Critical care medicine |
| description |
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 char-acteristics: 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. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of European Society for Clinical Nutrition and Metabolism. |
| publishDate |
2021 |
| dc.date.none.fl_str_mv |
2021 |
| dc.type.none.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
| format |
article |
| status_str |
publishedVersion |
| dc.identifier.none.fl_str_mv |
https://hdl.handle.net/2445/183104 |
| url |
https://hdl.handle.net/2445/183104 |
| dc.language.none.fl_str_mv |
Inglés |
| language_invalid_str_mv |
Inglés |
| dc.relation.none.fl_str_mv |
Reproducció del document publicat a: https://doi.org/10.1016/j.clnesp.2021.11.018 Clinical Nutrition ESPEN, 2021, vol 47, p. 325-332 https://doi.org/10.1016/j.clnesp.2021.11.018 |
| dc.rights.none.fl_str_mv |
cc by-nc-nd (c) Servia Goixart, Lluís et al, 2021 http://creativecommons.org/licenses/by-nc-nd/3.0/es/ info:eu-repo/semantics/openAccess |
| rights_invalid_str_mv |
cc by-nc-nd (c) Servia Goixart, Lluís et al, 2021 http://creativecommons.org/licenses/by-nc-nd/3.0/es/ |
| eu_rights_str_mv |
openAccess |
| dc.format.none.fl_str_mv |
application/pdf |
| dc.publisher.none.fl_str_mv |
Elsevier BV |
| publisher.none.fl_str_mv |
Elsevier BV |
| dc.source.none.fl_str_mv |
Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL)) reponame:Dipòsit Digital de la UB instname:Universidad de Barcelona |
| instname_str |
Universidad de Barcelona |
| reponame_str |
Dipòsit Digital de la UB |
| collection |
Dipòsit Digital de la UB |
| repository.name.fl_str_mv |
|
| repository.mail.fl_str_mv |
|
| _version_ |
1869417859443064832 |
| score |
15,301603 |