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Critical Care
Published in: Critical Care 1/2024

Open Access 01-12-2024 | Nutrition | Research

Enhanced exclusive enteral nutrition delivery during the first 7 days is associated with decreased 28-day mortality in critically ill patients with normal lactate level: a post hoc analysis of a multicenter randomized trial

Authors: Yizhe Chen, Zirui Liu, Qiuhui Wang, Fei Gao, Hongyang Xu, Lu Ke, Zheng-Yii Lee, Christian Stoppe, Daren K. Heyland, Fengming Liang, Jiajia Lin, for the Chinese Critical Care Nutrition Trials Group (CCCNTG)

Published in: Critical Care | Issue 1/2024

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Abstract

Background and aims

Exclusive enteral nutrition (EN) is often observed during the first week of ICU admission because of the extra costs and safety considerations for early parenteral nutrition. This study aimed to assess the association between nutrition intake and 28-day mortality in critically ill patients receiving exclusive EN.

Methods

This is a post hoc analysis of a cluster-randomized clinical trial that assesses the effect of implementing a feeding protocol on mortality in critically ill patients. Patients who stayed in the ICUs for at least 7 days and received exclusive EN were included in this analysis. Multivariable Cox hazard regression models and restricted cubic spline models were used to assess the relationship between the different doses of EN delivery and 28-day mortality. Subgroups with varying lactate levels at enrollment were additionally analyzed to address the potential confounding effect brought in by the presence of shock-related hypoperfusion.

Results

Overall, 1322 patients were included in the analysis. The median (interquartile range) daily energy and protein delivery during the first week of enrollment were 14.6 (10.3–19.6) kcal/kg and 0.6 (0.4–0.8) g/kg, respectively. An increase of 5 kcal/kg energy delivery was associated with a significant reduction (approximately 14%) in 28-day mortality (adjusted hazard ratio [HR] = 0.865, 95% confidence interval [CI]: 0.768–0.974, P = 0.016). For protein intake, a 0.2 g/kg increase was associated with a similar mortality reduction with an adjusted HR of 0.868 (95% CI 0.770–0.979). However, the benefits associated with enhanced nutrition delivery could be observed in patients with lactate concentration ≤ 2 mmol/L (adjusted HR = 0.804 (95% CI 0.674–0.960) for energy delivery and adjusted HR = 0.804 (95% CI 0.672–0.962) for protein delivery, respectively), but not in those > 2 mmol/L.

Conclusions

During the first week of critical illness, enhanced nutrition delivery is associated with reduced mortality in critically ill patients receiving exclusive EN, only for those with lactate concentration ≤ 2 mmol/L.
Trial registration: ISRCTN12233792, registered on November 24, 2017.
Appendix
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Metadata
Title
Enhanced exclusive enteral nutrition delivery during the first 7 days is associated with decreased 28-day mortality in critically ill patients with normal lactate level: a post hoc analysis of a multicenter randomized trial
Authors
Yizhe Chen
Zirui Liu
Qiuhui Wang
Fei Gao
Hongyang Xu
Lu Ke
Zheng-Yii Lee
Christian Stoppe
Daren K. Heyland
Fengming Liang
Jiajia Lin
for the Chinese Critical Care Nutrition Trials Group (CCCNTG)
Publication date
01-12-2024
Publisher
BioMed Central
Keyword
Nutrition
Published in
Critical Care / Issue 1/2024
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-024-04813-6

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