Mortality and overall and specific infection complication rates in patients who receive parenteral nutrition: systematic review and meta-analysis with trial sequential analysis
Open accessAbstract
Background Parenteral nutrition (PN) is an available option for nutritional therapy and is often required in the hospital setting to overcome malnutrition. Objectives The aim of this study was to assess whether PN is associated with an increased risk of mortality or infectious complications in all groups of hospitalized patients compared with those receiving other nutritional support strategies. Methods For this systematic review and meta-analysis MEDLINE, Embase, Cochrane Central, Scopus, clinicaltrials.gov, and Web of Science were searched for randomized controlled trials (RCTs) and observational studies with parallel groups that explored the effect of PN on mortality and infectious complications, published until March 2021. Two independent reviewers extracted the data and assessed the risk of bias. Fixed-effects meta-analysis was performed to compare the groups from RCTs. Trial sequential analysis (TSA) was used to identify whether the results were sufficient to reach definitive conclusions. Results Of the 83 included studies that compared patients receiving PN with those receiving other strategies, 67 RCTs were included in the meta-analysis. PN was not associated with a higher risk of mortality (RR: 1.01; 95% CI: 0.95, 1.07). On the other hand, PN was associated with a higher risk of infectious events (RR: 1.23; 95% CI: 1.12, 1.36). PN was specifically associated with abdominal infection and catheter infection. The TSA showed that there were sufficient data to make numerical conclusions about mortality, any infectious event, and abdominal infectious complications. Conclusions This study suggests that although PN is not associated with greater mortality in hospitalized patients, it is associated with infectious complications. Through TSA, definite conclusions about survival and infection rates could be made.This review was registered at www.crd.york.ac.uk/prospero/ as CRD42018075599.
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In 37 randomized controlled trials, parenteral nutrition compared with any other comparator was associated with an increased risk of infection at any site (relative risk, 1.23 [95% CI, 1.12-1.36]).
“When 37 randomized controlled trials investigating PN compared with any other comparator were evaluated, there was an increased risk of infection at any site (relative risk, 1.23 [95% CI, 1.12–1.36])”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [140]
In the same 37 randomized controlled trials, mortality was equivalent between parenteral nutrition and comparator groups.
“but mortality was equivalent between the 2 groups.140”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [140]
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A prospective observation on nutrition support in adult patients with severe burns
Guo, F., Zhou, H., Wu, J., Huang, Y., Lv, G., Wu, Y., Zhao, H., Jin, J., Zhao, F., Liu, L., et al. (2019) · British Journal Of Nutrition · doi:10.1017/s0007114519000217 · Cited by 21 · see citing works
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Comparison of the Preference of Nutritional Support for Patients With Severe Acute Pancreatitis
Hui, L., Zang, K., Wang, M., Shang, F., & Zhang, G. (2019) · Gastroenterology Nursing · doi:10.1097/sga.0000000000000331 · Cited by 18 · see citing works
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Intravascular Complications of Central Venous Catheterization by Insertion Site
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Parenteral nutrition: a clear and present danger unabated by tight glucose control
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Resultados del soporte nutricional en una UCI polivalente
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Flagged first, then by citations
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ESPEN guideline on nutrition and hydration in dementia – Update 2024
Volkert, D., Beck, A. M., Irving, G. F., Frühwald, T., Hooper, L., Keller, H., Porter, J. A., Rothenberg, E. M., Suominen, M. H., Wirth, R., et al. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.04.039 · Cited by 121 · see citing works
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Gastric Motility Disorders Post Organ Transplantation—A Comprehensive Review
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“Although PN has long been viewed as a high-risk infusion, current evidence does not show significantly different rates of CRBSI between patients receiving PN and those having other infusions (Comerlato et al., 2021; Gavin et al., 2017).”
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BackgroundBezmarević, M., Palibrk, I., Stojsic, M., Vuković, N., Djukanović, M., Jovanović, D., Krdžić, I., Simić, D., Pantic, I., Panisic-Sekeljic, M., et al. (2025) · Vojnosanitetski pregled · doi:10.2298/vsp250307055b
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Clinical Follow-Up After Intestinal Transplantation
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Factors Associated With 14-Day Reintubation and Outcomes in Surgical Intensive Care Unit Patients
Lin, T., Chen, Y.-J., Chang, P.-H., Liu, E.-H., Lai, W.-H., Chen, I., Li, W.-F., Liu, Y.-W., & Hsieh, C. (2026) · Journal of Surgical Research · doi:10.1016/j.jss.2026.07.023
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Nutritional support for severe malnutrition in newly diagnosed Crohn’s disease: a case report
Canova, D., Cingolani, L., & Schiavo, G. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1922931
- Authors
- Comerlato, P. H., Stefani, J., & Viana, L. V.
- Affiliations
- Universidade Federal do Rio Grande do Sul (BR)
- Hospital de Clínicas de Porto Alegre (BR)
- Corresponding author
- Comerlato, Pedro H
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2021-10
- Volume
- 114
- Issue
- 4
- Pages
- 1535-1545
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W3180927682
- Cited by
- 20
- References
- 110
- Citations by year
- 2026: 9 · 2025: 5 · 2024: 3 · 2023: 1 · 2022: 2
- FWCI
- 0.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Health Professions › Emergency Medical Services › Central Venous Catheters and Hemodialysis
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Keywords
- parenteral nutrition, mortality, infectious complications, catheter-related infection, intra-abdominal infection, nutritional support, hospitalized patients, trial sequential analysis
- MeSH terms
- Bacterial Infections, Humans, Mortality, Parenteral Nutrition, Risk Factors, Catheter-Related Infections
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