Evaluation of Nutritional Practices in the Critical Care patient (The ENPIC study): Does nutrition really affect ICU mortality?
Lluís Servia-Goixart, Juan C Lopez-Delgado, Teodoro Grau-Carmona, Javier Trujillano-Cabello, M Luisa Bordeje-Laguna, Esther Mor-Marco, Esther Portugal-Rodriguez, Carol Lorencio-Cardenas, Juan C Montejo-Gonzalez, Paula Vera-Artazcoz, Laura Macaya-Redin, Juan Francisco Martinez-Carmona, Rayden Iglesias-Rodriguez, Diana Monge-Donaire, José L Flordelis-Lasierra, Beatriz Llorente-Ruiz, Eva M Menor-Fernández, Itziar Martínez de Lagrán, Juan C Yebenes-Reyes, ENPIC Study Investigators, Lluís Servia-Goixart, Javier Trujillano-Cabello, Joan Escobar-Ortiz, Neus Montserrat-Ortiz, Amalia Zapata-Rojas, Teodoro Grau-Carmona, Iris Bautista-Redondo, Ana Cruz-Ramos, Laura Diaz-Castellanos, Miriam Morales-Cifuentes, Montserrat Plaza- Bono, Juan Carlos Montejo-Gonzalez, Susana Temprano-Vazquez, Veronica Arjona-Diaz, Carlos Garcia-Fuentes, Carolina Mudarra-Reche, Maria Orejana-Martin, Juan Carlos Lopez-Delgado, Africa Lores-Obradors, Laura Anguela-Calvet, Gloria Muñoz-Del Río, Pamela Alejandra Revelo-Esquibel, Henry Alanez-Saavedra, Pau Serra-Paya, Stephani Maria Luna-Solis, Alvaro Salinas-Canovas, Fernando De Frutos-Seminario, Oriol Rodriguez-Queralto, Carlos Gonzalez-Iglesias, Monica Zamora-Elson, Eugenia de la Fuente-O'Connor, Carlos Seron- Arbeloa, Nestor Bueno-Vidales, Rayden Iglesias-Rodriguez, Ana Martin-Luengo, Angel Sanchez-Miralles, Enrique Marmol-Peis, Miriam Ruiz-Miralles, Maria Gonzalez-Sanz, Arantzazu Server-Martinez, Belen Vila-Garcia, Carol Lorencio-Cardenas, Laura Macaya-Redin, Raquel Flecha-Viguera, Sara Aldunate-Calvo, Jose Luis Flordelis-Lasierra, Irene Jimenez-Del Rio, Jose Ramon Mampaso-Recio, Jose Manuel Rodriguez-Roldan, Rosa Gastaldo-Simeon, Josefina Gimenez-Castellanos, Juan Francisco Fernandez-Ortega, Juan F Martinez-Carmona, Esther Lopez-Luque, Ane Ortega-Ordiales, Monica Crespo-Gomez, Victor Ramirez-Montero, Esther Lopez-García, Arturo Navarro-Lacalle, Pilar Martinez-Garcia, Maria Inmaculada Dominguez-Fernandez, Paula Vera-Artazcoz, Marta Izura-Gomez, Susana Hernandez-Duran, Ma Luisa Bordeje-Laguna, Esther Mor-Marco, Yaiza Rovira-Valles, Viridiana Philibert, Maravillas de Las Nieves Alcazar-Espin, Aurea Higon-Cañigral, Enrique Calvo-Herranz, Diego Manzano-Moratinos, Esther Portugal-Rodriguez, David Andaluz-Ojeda, Laura Parra-Morais, Rafael Citores-Gonzalez, Maria Teresa Garcia-Gonzalez, Gloria Renedo Sanchez-Giron, Elisabeth Navas-Moya, Carles Ferrer-Pereto, Cristina Lluch-Candal, Jessica Ruiz-Izquierdo, Silvia Castor-Bekari, Cristina Leon-Cinto, Itziar Martinez de Lagran, Juan Carlos Yebenes-Reyes, Beatriz Nieto-Martino, Clara Vaquerizo-Alonso, Susana Almanza-Lopez, Sonia Perez-Quesada, Jose Luis Anton-Pascual, Judith Marin-Corral, Maite Sistachs-Baquedano, Maria Hacer-Puig, Marina Picornell-Noguera, Lidon Mateu-Campos, Clara Martinez-Valero, Andrea Ortiz-Suñer, Beatriz Llorente-Ruiz, María Cristina Martinez-Diaz, Maria Trascasa- Muñoz De La Peña, Diego Anibal Rodriguez-Serrano, Leticia Fernandez-Salvatierra, Mireia Barcelo-Castello, Paula Millan-Taratiel, Antonio Tejada-Artigas, Ines Martinez-Arroyo, Pilar Araujo-Aguilar, Maria Fuster-Cabre, Laura Andres-Gines, Sonia Soldado-Olmo, Eva Mª Menor-Fernandez, Lucas Lage-Cendon, Alberto Touceda-Bravo, Laura Sanchez-Ales, Laura Almorin-Gonzalvez, Maria Gero-Escapa, Esther Martinez-Barrio, Sergio Ossa-Echeverri, Diana Monge-Donaire, Lluís Servia-Goixart, Juan C Lopez-Delgado, Teodoro Grau-Carmona, Javier Trujillano-Cabello, M Luisa Bordeje-Laguna, Esther Mor-Marco, Esther Portugal-Rodriguez, Carol Lorencio-Cardenas, Juan C Montejo-Gonzalez, Paula Vera-Artazcoz, Laura Macaya-Redin, Juan Francisco Martinez-Carmona, Rayden Iglesias-Rodriguez, Diana Monge-Donaire, José L Flordelis-Lasierra, Beatriz Llorente-Ruiz, Eva M Menor-Fernández, Itziar Martínez de Lagrán, Juan C Yebenes-Reyes, ENPIC Study Investigators, Lluís Servia-Goixart, Javier Trujillano-Cabello, Joan Escobar-Ortiz, Neus Montserrat-Ortiz, Amalia Zapata-Rojas, Teodoro Grau-Carmona, Iris Bautista-Redondo, Ana Cruz-Ramos, Laura Diaz-Castellanos, Miriam Morales-Cifuentes, Montserrat Plaza- Bono, Juan Carlos Montejo-Gonzalez, Susana Temprano-Vazquez, Veronica Arjona-Diaz, Carlos Garcia-Fuentes, Carolina Mudarra-Reche, Maria Orejana-Martin, Juan Carlos Lopez-Delgado, Africa Lores-Obradors, Laura Anguela-Calvet, Gloria Muñoz-Del Río, Pamela Alejandra Revelo-Esquibel, Henry Alanez-Saavedra, Pau Serra-Paya, Stephani Maria Luna-Solis, Alvaro Salinas-Canovas, Fernando De Frutos-Seminario, Oriol Rodriguez-Queralto, Carlos Gonzalez-Iglesias, Monica Zamora-Elson, Eugenia de la Fuente-O'Connor, Carlos Seron- Arbeloa, Nestor Bueno-Vidales, Rayden Iglesias-Rodriguez, Ana Martin-Luengo, Angel Sanchez-Miralles, Enrique Marmol-Peis, Miriam Ruiz-Miralles, Maria Gonzalez-Sanz, Arantzazu Server-Martinez, Belen Vila-Garcia, Carol Lorencio-Cardenas, Laura Macaya-Redin, Raquel Flecha-Viguera, Sara Aldunate-Calvo, Jose Luis Flordelis-Lasierra, Irene Jimenez-Del Rio, Jose Ramon Mampaso-Recio, Jose Manuel Rodriguez-Roldan, Rosa Gastaldo-Simeon, Josefina Gimenez-Castellanos, Juan Francisco Fernandez-Ortega, Juan F Martinez-Carmona, Esther Lopez-Luque, Ane Ortega-Ordiales, Monica Crespo-Gomez, Victor Ramirez-Montero, Esther Lopez-García, Arturo Navarro-Lacalle, Pilar Martinez-Garcia, Maria Inmaculada Dominguez-Fernandez, Paula Vera-Artazcoz, Marta Izura-Gomez, Susana Hernandez-Duran, Ma Luisa Bordeje-Laguna, Esther Mor-Marco, Yaiza Rovira-Valles, Viridiana Philibert, Maravillas de Las Nieves Alcazar-Espin, Aurea Higon-Cañigral, Enrique Calvo-Herranz, Diego Manzano-Moratinos, Esther Portugal-Rodriguez, David Andaluz-Ojeda, Laura Parra-Morais, Rafael Citores-Gonzalez, Maria Teresa Garcia-Gonzalez, Gloria Renedo Sanchez-Giron, Elisabeth Navas-Moya, Carles Ferrer-Pereto, Cristina Lluch-Candal, Jessica Ruiz-Izquierdo, Silvia Castor-Bekari, Cristina Leon-Cinto, Itziar Martinez de Lagran, Juan Carlos Yebenes-Reyes, Beatriz Nieto-Martino, Clara Vaquerizo-Alonso, Susana Almanza-Lopez, Sonia Perez-Quesada, Jose Luis Anton-Pascual, Judith Marin-Corral, Maite Sistachs-Baquedano, Maria Hacer-Puig, Marina Picornell-Noguera, Lidon Mateu-Campos, Clara Martinez-Valero, Andrea Ortiz-Suñer, Beatriz Llorente-Ruiz, María Cristina Martinez-Diaz, Maria Trascasa- Muñoz De La Peña, Diego Anibal Rodriguez-Serrano, Leticia Fernandez-Salvatierra, Mireia Barcelo-Castello, Paula Millan-Taratiel, Antonio Tejada-Artigas, Ines Martinez-Arroyo, Pilar Araujo-Aguilar, Maria Fuster-Cabre, Laura Andres-Gines, Sonia Soldado-Olmo, Eva Mª Menor-Fernandez, Lucas Lage-Cendon, Alberto Touceda-Bravo, Laura Sanchez-Ales, Laura Almorin-Gonzalvez, Maria Gero-Escapa, Esther Martinez-Barrio, Sergio Ossa-Echeverri, Diana Monge-Donaire
Abstract
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 characteristics: 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.
Trial registration: ClinicaTrials.gov NCT: 03634943.
Trial registration: ClinicalTrials.gov NCT03634943.
Keywords: Enteral nutrition; Intensive care unit; Mortality; Nutritional therapy; Parenteral nutrition.
Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Source: PubMed