Prognostic Value of Prolonged Feeding Intolerance in Predicting All‐Cause Mortality in Critically Ill Patients: A Multicenter, Prospective, Observational Study
Abstract
Background: The 2012 European Society of Intensive Care Medicine (ESICM) guidelines provided a clear definition of feeding intolerance (FI). The study aimed to investigate the association between FI based on the current ESICM definition and clinical outcome and to further explore the effect of the duration of FI on mortality. Methods: Adult patients from 14 general intensive care units (ICUs) with an expected ICU stay ≥24 hours were prospectively studied. Based on FI duration in the first week of admission to the ICU, FI was categorized as 7‐day persistent feeding tolerance (FT), delayed FT, delayed FI, and 7‐day persistent FI. The primary outcomes were 28‐day and 60‐day all‐cause mortality. Results: Of 499 patients, the prevalence of 3‐day and 7‐day persistent FI was 39.2% (n = 196) and 25.4% (n = 106), respectively. The patients with 3‐day FT had lower risk of 28‐day and 60‐day mortality rates and higher prevalence in ventilator weaning and vasoactive medication on the seventh day of ICU admission than those with 3‐day FI. Three‐day FI remained an independent predictor for 60‐day mortality. In a subgroup analysis including 418 patients with 7‐day survival, compared with those with 7‐day persistent FT, the odds ratios of 60‐day mortality were 1.67, 1.97, and 2.62 in the patients with delayed FT, delayed FI, and 7‐day persistent FI, respectively. Conclusion: FI was associated with increased mortality and longer duration of mechanical ventilation and vasoactive support. Prolonged or relapsing FI represented an incremental risk of adverse outcomes in critically ill patients.
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The presence and persistence of enteral feeding intolerance may reflect more than just reduced energy delivery.
“The presence and persistence of EFI may reflect more than just reduced energy delivery.”
From The impact of enteral feeding intolerance on the prognosis of patients with septic shock in South Korea (2025) · cites this paper as [32]
Enteral feeding intolerance may be associated with impaired gut motility, increased mucosal permeability, and compromised nutrient absorption, all of which can promote systemic inflammation and contribute to multiple organ failure.
“It may be associated with impaired gut motility, increased mucosal permeability, and compromised nutrient absorption, all of which can promote systemic inflammation and contribute to multiple organ failure [32].”
From The impact of enteral feeding intolerance on the prognosis of patients with septic shock in South Korea (2025) · cites this paper as [32]
Cites
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock
Dellinger, R. P., Levy, M. M., Rhodes, A., Annane, D., Gerlach, H., Opal, S. M., Sevransky, J. E., Sprung, C. L., Douglas, I. S., Jaeschke, R., et al. (2013) · Critical Care Medicine · doi:10.1097/ccm.0b013e31827e83af · Cited by 9,694 · see citing works
Dellinger, R. P., Levy, M. M., Rhodes, A., Annane, D., Gerlach, H., Opal, S. M., Sevransky, J., Sprung, C. L., Douglas, I. S., Jaeschke, R., et al. (2013) · Intensive Care Medicine · doi:10.1007/s00134-012-2769-8 · Cited by 7,282 · see citing works
Dellinger, R. P., Levy, M. M., Carlet, J. M., Bion, J., Parker, M. M., Jaeschke, R., Reinhart, K., Angus, D. C., Brun‐Buisson, C., Beale, R. J., et al. (2007) · Intensive Care Medicine · doi:10.1007/s00134-007-0934-2 · Cited by 6,722 · see citing works
McClave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., et al. (2016) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607115621863 · Cited by 3,982 · see citing works
ESPEN Guidelines for Nutrition Screening 2002
Kondrup, J. (2003) · Clinical Nutrition · doi:10.1016/s0261-5614(03)00098-0 · Cited by 3,159 · see citing works
McClave, S. A., Martindale, R. G., Vanek, V. W., McCarthy, M., Roberts, P., Taylor, B., Ochoa, J. B., Napolitano, L., Cresci, G., the A.S.P.E.N. Board of Directors, et al. (2009) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607109335234 · Cited by 1,873 · see citing works
Early versus late parenteral nutrition in critically ill adults
Casaer, M. P., Mesotten, D., Hermans, G., Wouters, P. J., Schetz, M., Meyfroidt, G., Van Cromphaut, S., Ingels, C., Meersseman, P., Muller, J., et al. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1102662 · Cited by 1,696 · see citing works
ESPEN guidelines on enteral nutrition: intensive care
Kreymann, K. G., Berger, M. M., Deutz, N. E. P., Hiesmayr, M., Jolliet, P., Kazandjiev, G., Nitenberg, G., van den Berghe, G., Wernerman, J., Ebner, C., et al. (2006) · Clinical Nutrition · doi:10.1016/j.clnu.2006.01.021 · Cited by 1,366 · see citing works
Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines
ESICM Working Group on Gastrointestinal Function, Reintam Blaser, A., Starkopf, J., Alhazzani, W., Berger, M. M., Casaer, M. P., Deane, A. M., Fruhwald, S., Hiesmayr, M., Ichai, C., et al. (2017) · Intensive Care Medicine · doi:10.1007/s00134-016-4665-0 · Cited by 837 · see citing works
Blaser, A. R., Malbrain, M. L. N. G., Starkopf, J., Fruhwald, S. M., Jakob, S. M., Waele, J. J. D., Braun, J.-P., Poeze, M., & Spies, C. (2012) · Intensive Care Medicine · doi:10.1007/s00134-011-2459-y · Cited by 651 · see citing works
Reignier, J., Boisramé-Helms, J., Brisard, L., Lascarrou, J.-B., Ait Hssain, A., Anguel, N., Argaud, L., Asehnoune, K., Asfar, P., Bellec, F., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(17)32146-3 · Cited by 595 · see citing works
Mentec, H., Dupont, H., Bocchetti, M., Cani, P., Ponche, F., & Bleichner, G. (2001) · Critical Care Medicine · doi:10.1097/00003246-200110000-00018 · Cited by 580 · see citing works
ASPEN Safe Practices for Enteral Nutrition Therapy
Boullata, J. I., Carrera, A. L., Harvey, L. P., Escuro, A. A., Hudson, L. M., Mays, A., McGinnis, C., Wessel, J., Bajpai, S., Beebe, M. L., et al. (2016) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607116673053 · Cited by 514 · see citing works
Clark, J. A., & Coopersmith, C. M. (2007) · Shock · doi:10.1097/shk.0b013e31805569df · Cited by 443 · see citing works
Gungabissoon, U., Hacquoil, K. E., Bains, C., Irizarry, M. C., Dukes, G. E., Williamson, R., Deane, A. M., & Heyland, D. K. (2014) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607114526450 · Cited by 283 · see citing works
Gastrointestinal Failure score in critically ill patients: a prospective observational study
Blaser, A. R., Parm, P., Kitus, R., Starkopf, J., & Kern, H. (2008) · Critical Care · doi:10.1186/cc6958 · Cited by 240 · see citing works
BLASER, A. R., STARKOPF, J., KIRSIMÄGI, Ü., & DEANE, A. M. (2014) · Acta Anaesthesiologica Scandinavica · doi:10.1111/aas.12302 · Cited by 231 · see citing works
Marvin, R. G., McKinley, B. A., McQuiggan, M. M., Cocanour, C. S., & Moore, F. A. (2000) · The American Journal of Surgery · doi:10.1016/s0002-9610(99)00261-5 · Cited by 163 · see citing works
Mechanisms underlying feed intolerance in the critically ill: Implications for treatment
Deane, A. M. (2007) · World Journal of Gastroenterology · doi:10.3748/wjg.v13.i29.3909 · Cited by 136 · see citing works
Hu, B., Sun, R., Wu, A., Yin, N., Liu, J., Guo, F., Ying, L., Ge, G., Ding, A., Shi, Y., et al. (2017) · Critical Care · doi:10.1186/s13054-017-1780-4 · Cited by 128 · see citing works
Self-citationComparison of different definitions of feeding intolerance: A retrospective observational study
Blaser, A. R., Starkopf, L., Deane, A. M., Poeze, M., & Starkopf, J. (2014) · Clinical Nutrition · doi:10.1016/j.clnu.2014.10.006 · Cited by 111 · see citing works
Shimizu, K., Ogura, H., Asahara, T., Nomoto, K., Morotomi, M., Nakahori, Y., Osuka, A., Yamano, S., Goto, M., Matsushima, A., et al. (2010) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2010.01653.x · Cited by 94 · see citing works
Enteral Nutrition in Critical Care
Arbeloa, C. S. (2013) · Journal of Clinical Medicine Research · doi:10.4021/jocmr1210w · Cited by 92 · see citing works
Summary of round table conference: gut dysfunction in critical illness
Rombeau, J. L., & Takala, J. A. (1997) · Intensive Care Medicine · doi:10.1007/s001340050361 · Cited by 77 · see citing works
Kuppinger, D., Rittler, P., Hartl, W. H., & Rüttinger, D. (2013) · Nutrition · doi:10.1016/j.nut.2013.01.025 · Cited by 76 · see citing works
Prokinetic drugs for feed intolerance in critical illness: current and potential therapies
Deane, A. M., Fraser, R. J., & Chapman, M. J. (2009) · Critical Care and Resuscitation · doi:10.1016/s1441-2772(23)01538-7 · Cited by 70 · see citing works
Gastrointestinal failure in the ICU
Blaser, A. R., Jakob, S. M., & Starkopf, J. (2016) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000286 · Cited by 64 · see citing works
Nguyen, N. Q., Ching, K. J., Fraser, R. J., Chapman, M. J., & Holloway, R. H. (2007) · Intensive Care Medicine · doi:10.1007/s00134-007-0869-7 · Cited by 60 · see citing works
Enteral nutrition associated non-occlusive bowel ischemia
Gwon, J. G., Lee, Y.-J., Kyoung, K.-H., Kim, Y., & Hong, S. (2012) · Journal of the Korean Surgical Society · doi:10.4174/jkss.2012.83.3.171 · Cited by 23 · see citing works
Macfie, J. M. (2013) · British journal of surgery · doi:10.1002/bjs.9155_1 · Cited by 8 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Enteral Feeding Intolerance: Updates in Definitions and Pathophysiology
Reintam Blaser, A., Deane, A. M., Preiser, J., Arabi, Y. M., & Jakob, S. M. (2021) · Nutrition in Clinical Practice · doi:10.1002/ncp.10599 · Cited by 156 · see citing works
Jenkins, B., Calder, P. C., & Marino, L. V. (2022) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2022.04.014 · Cited by 71 · see citing works
Ma, Y., Cheng, J., Liu, L., Chen, K., Fang, Y., Wang, G., Zhu, J., & Chen, L. (2020) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2020.103783 · Cited by 60 · see citing works
Li, J., Wang, L., Zhang, H., Zou, T., Kang, Y., He, W., Xu, Y., & Yin, W. (2023) · Journal of Intensive Care · doi:10.1186/s40560-023-00674-3 · Cited by 49 · see citing works
Stoian, M., Andone, A., Bândilă, S. R., Onișor, D. M., Babă, D.-F., Niculescu, R., Stoian, A., & Azamfirei, L. (2025) · Nutrients · doi:10.3390/nu17101659 · Cited by 49 · see citing works
Kagan, I., Hellerman-Itzhaki, M., Bendavid, I., Statlender, L., Fishman, G., Wischmeyer, P. E., Waele, E. D., & Singer, P. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.06.018 · Cited by 32 · see citing works
Feeding intolerance and risk of poor outcome in patients undergoing cardiopulmonary bypass surgery
Lin, Y., Chen, M., Peng, Y., Chen, Q., Li, S., & Chen, L. (2021) · British Journal Of Nutrition · doi:10.1017/s0007114521000167 · Cited by 30 · see citing works
Peng, R., Li, H., Yang, L., Zeng, L., Yi, Q., Xu, P., Pan, X., & Zhang, L. (2021) · PLoS ONE · doi:10.1371/journal.pone.0245317 · Cited by 33 · see citing works
Lu, X., Jia, D.-S., Wang, R., Yang, Q., Jin, S.-S., & Chen, L. (2022) · World Journal of Gastrointestinal Surgery · doi:10.4240/wjgs.v14.i12.1363 · Cited by 24 · see citing works
Yu, K., Guo, N., Zhang, D., Xia, Y., Meng, Y., Weng, L., & Du, B. (2022) · Chinese Medical Journal · doi:10.1097/cm9.0000000000001974 · Cited by 23 · see citing works
Guan, X., Chen, D., & Xu, Y. (2024) · Journal of Intensive Medicine · doi:10.1016/j.jointm.2023.12.002 · Cited by 23 · see citing works
Villar, J., González-Martín, J. M., Añón, J. M., Ferrando, C., Soler, J. A., Mosteiro, F., Mora-Ordóñez, J. M., Ambrós, A., Fernández, L., Montiel, R., et al. (2023) · Scientific Reports · doi:10.1038/s41598-023-28824-5 · Cited by 10 · see citing works
Fang, Y., Ma, Y., He, H., Chen, T., Fu, J., & Zhu, J. (2022) · International Journal of Nursing Sciences · doi:10.1016/j.ijnss.2022.06.014 · Cited by 9 · see citing works
Elmokadem, E. M., Fadl, D. K. A. E., Eissa, N., Alnassar, N. A., Bassiouny, A. M., Samy, A. E. H., & Said, N. O. E. (2024) · Frontiers in Pharmacology · doi:10.3389/fphar.2024.1413246 · Cited by 6 · see citing works
Liu, L., Li, J., Hu, L., Cai, X., Li, X., & Bai, Y. (2025) · Journal of Clinical Nursing · doi:10.1111/jocn.17660 · Cited by 6 · see citing works
The intensivist's assessment of gastrointestinal function: A pilot study
Asrani, V. M., McArthur, C. J., Bissett, I. P., & Windsor, J. A. (2021) · Australian Critical Care · doi:10.1016/j.aucc.2021.10.008 · Cited by 6 · see citing works
Zhu, L., & Gong, Y. (2021) · Journal of Healthcare Engineering · doi:10.1155/2021/2883597 · Cited by 6 · see citing works
Beattie, C. E., Thomas, M., Borislavova, B., Smith, H., Ambler, M. T., White, P., Hayes, K., Milne, D., Ramesh, A. V., Gonzalez, J. T., et al. (2024) · BMJ Open · doi:10.1136/bmjopen-2024-086540 · Cited by 5 · see citing works
Park, H.-J., Ahn, Y. H., Lee, H. Y., Lee, S.-M., & Lee, J. (2025) · Acute and Critical Care · doi:10.4266/acc.000700 · Cited by 3 · see citing works
Yin, Y., & Fan, C.-F. (2023) · Patient Preference and Adherence · doi:10.2147/ppa.s438190 · Cited by 2 · see citing works
Li, J., Wang, L., Zhang, H., Zou, T., Kang, Y., Liao, X., He, W., Xu, Y., & Yin, W. (2022) · Research Square · doi:10.21203/rs.3.rs-2123438/v1 · Cited by 2 · see citing works
He, C., Li, X., Li, F., Xia, Y., & Yu, K. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1666339 · Cited by 1 · see citing works
(2020) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.1569 · Cited by 1 · see citing works
Duan, Y.-Y., Zhou, Q., Dang, W., Ma, Y., Huang, L., & Hu, A. (2022) · Topics in Clinical Nutrition · doi:10.1097/tin.0000000000000305
Yao, Y., Liu, J., Xue, H., Wang, X., Yao, W., Liu, N., Wang, Z., & Mi, G. (2023) · Saudi Journal of Gastroenterology · doi:10.4103/sjg.sjg_205_23
Self-citationLi, J., Wang, L., Zhang, H., 邹同娟, Kang, Y., He, W., Xu, Y., & Yin, W. (2023) · Figshare · doi:10.6084/m9.figshare.23632534
Li, J., Wang, L., Zhang, H., 邹同娟, Kang, Y., He, W., Xu, Y., & Yin, W. (2023) · Figshare · doi:10.6084/m9.figshare.23632540
Li, J., Wang, L., Zhang, H., 邹同娟, Kang, Y., He, W., Xu, Y., & Yin, W. (2023) · Figshare · doi:10.6084/m9.figshare.23632555
Li, J., Wang, L., Zhang, H., 邹同娟, Kang, Y., He, W., Xu, Y., & Yin, W. (2023) · Figshare · doi:10.6084/m9.figshare.23632552
Li, J., Wang, L., Zhang, H., 邹同娟, Kang, Y., He, W., Xu, Y., & Yin, W. (2023) · Figshare · doi:10.6084/m9.figshare.23632567
Li, J., Wang, L., Zhang, H., 邹同娟, Kang, Y., He, W., Xu, Y., & Yin, W. (2023) · Figshare · doi:10.6084/m9.figshare.23632579
Li, J., Wang, L., Zhang, H., 邹同娟, Kang, Y., He, W., Xu, Y., & Yin, W. (2023) · Figshare · doi:10.6084/m9.figshare.23632573
Li, J., Wang, L., Zhang, H., 邹同娟, Kang, Y., He, W., Xu, Y., & Yin, W. (2023) · Figshare · doi:10.6084/m9.figshare.23632582
Li, J., Wang, L., Zhang, H., 邹同娟, Kang, Y., He, W., Xu, Y., & Yin, W. (2023) · Figshare · doi:10.6084/m9.figshare.23632546
Li, J., Wang, L., Zhang, H., 邹同娟, Kang, Y., He, W., Xu, Y., & Yin, W. (2023) · Figshare · doi:10.6084/m9.figshare.23632561
Li, J., Wang, L., Zhang, H., 邹同娟, Kang, Y., He, W., Xu, Y., & Yin, W. (2023) · Figshare · doi:10.6084/m9.figshare.23632570
Li, J., Wang, L., Zhang, H., 邹同娟, Kang, Y., He, W., Xu, Y., & Yin, W. (2023) · Figshare · doi:10.6084/m9.figshare.23632558
Li, J., Wang, L., Zhang, H., 邹同娟, Kang, Y., He, W., Xu, Y., & Yin, W. (2023) · Figshare · doi:10.6084/m9.figshare.23632549
Li, J., Wang, L., Zhang, H., 邹同娟, Kang, Y., He, W., Xu, Y., & Yin, W. (2023) · Figshare · doi:10.6084/m9.figshare.23632543
Li, J., Wang, L., Zhang, H., 邹同娟, Kang, Y., He, W., Xu, Y., & Yin, W. (2023) · Figshare · doi:10.6084/m9.figshare.23632537
Li, J., Wang, L., Zhang, H., 邹同娟, Kang, Y., He, W., Xu, Y., & Yin, W. (2023) · Figshare · doi:10.6084/m9.figshare.23632585
Wang, Y., Blaser, A. R., Li, Y., Lew, C. C. H., Li, H., Li, X., Ke, L., & Zhang, D. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1729192
Enteral Feeding Intolerance Diagnostic Criteria And Current Approaches; Classic Review
Kıray, G. D., & Okuroğlu, G. K. (2026) · CURARE Journal of Nursing · doi:10.26650/curare.2026.1807990
- Authors
- Hu, B., Sun, R., Wu, A., Ni, Y., Liu, J., Guo, F., Ying, L., Ge, G., Ding, A., Shi, Y., Liu, C., Xu, L., Jiang, R., Lu, J., Lin, R., Zhu, Y., Wu, W., & Xie, B.
- Affiliations
- Zhejiang Provincial People's Hospital (CN)
- ICU Zhejiang Provincial People's Hospital Hangzhou P. R. China
- Sir Run Run Shaw Hospital (CN)
- Shaoxing People's Hospital (CN)
- ICU Jinhua People's Hospital Jinhua P. R. China
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (CN)
- First Hospital of Jiaxing (CN)
- Affiliated Hangzhou First People's Hospital, Westlake University, School of Medicine (CN)
- Ningbo Medical Center Lihuili Hospital (CN)
- Zhejiang Chinese Medical University (CN)
- Zhejiang Taizhou Hospital (CN)
- Lishui Central Hospital (CN)
- Huzhou Central Hospital (CN)
- Corresponding author
- Sun, Renhua
- ORCID
- Venue
- Journal of Parenteral and Enteral Nutrition
- Publisher
- Wiley
- Published
- 2019-08-20
- Volume
- 44
- Issue
- 5
- Pages
- 855-865
- ISSN
- 0148-6071 (ISSN-L)
- 1941-2444
- OpenAlex
- W2969987252
- Cited by
- 43
- References
- 30
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 3 · 2023: 21 · 2022: 6 · 2021: 4 · 2020: 3
- FWCI
- 2.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Parenteral and Enteral Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Natural Science Foundation of Zhejiang Province (LY17H15000)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Keywords
- feeding intolerance, all-cause mortality, critically ill patients, intensive care unit, mechanical ventilation, vasoactive support, weaning from mechanical ventilation, prognostic factors, enteral nutrition
- MeSH terms
- Adult, Enteral Nutrition, Humans, Infant, Newborn, Intensive Care Units, Mortality, Prognosis, Prospective Studies, Respiration, Artificial, Critical Illness
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