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Cited by 116Clinical Nutrition and GastroenterologyHyperglycemia and glycemic control in critically ill and hospitalized patientsSepsis Diagnosis and Treatment

Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study

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Pardo, Emmanuel, Lescot, Thomas, Preiser, Jean-Charles, Massanet, Pablo, Pons, Antoine, Jaber, Samir, Fraipont, Vincent, Levesque, Eric +28 more·2023·Critical Care
DOI 10.1186/s13054-022-04298-1PMC PMC9826592
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Abstract

Background: Current guidelines suggest the introduction of early nutrition support within the first 48 h of admission to the intensive care unit (ICU) for patients who cannot eat. In that context, we aimed to describe nutrition practices in the ICU and study the association between the introduction of early nutrition support (< 48 h) in the ICU and patient mortality at day 28 (D28) using data from a multicentre prospective cohort. Methods: The ‘French-Speaking ICU Nutritional Survey’ (FRANS) study was conducted in 26 ICUs in France and Belgium over 3 months in 2015. Adult patients with a predicted ICU length of stay > 3 days were consecutively included and followed for 10 days. Their mortality was assessed at D28. We investigated the association between early nutrition (< 48 h) and mortality at D28 using univariate and multivariate propensity-score-weighted logistic regression analyses. Results: During the study period, 1206 patients were included. Early nutrition support was administered to 718 patients (59.5%), with 504 patients receiving enteral nutrition and 214 parenteral nutrition. Early nutrition was more frequently prescribed in the presence of multiple organ failure and less frequently in overweight and obese patients. Early nutrition was significantly associated with D28 mortality in the univariate analysis (crude odds ratio (OR) 1.69, 95% confidence interval (CI) 1.23–2.34) and propensity-weighted multivariate analysis (adjusted OR (aOR) 1.05, 95% CI 1.00–1.10). In subgroup analyses, this association was stronger in patients ≤ 65 years and with SOFA scores ≤ 8. Compared with no early nutrition, a significant association was found of D28 mortality with early enteral (aOR 1.06, 95% CI 1.01–1.11) but not early parenteral nutrition (aOR 1.04, 95% CI 0.98–1.11). Conclusions: In this prospective cohort study, early nutrition support in the ICU was significantly associated with increased mortality at D28, particularly in younger patients with less severe disease. Compared to no early nutrition, only early enteral nutrition appeared to be associated with increased mortality. Such findings are in contrast with current guidelines on the provision of early nutrition support in the ICU and may challenge our current practices, particularly concerning patients at low nutrition risk. Trial registration ClinicalTrials.gov Identifier: NCT02599948. Retrospectively registered on November 5th 2015.

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  • Early full EN may even be more detrimental than early full PN.

    “In fact, early full EN may even be more detrimental than early full PN [34].”

    From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [34]

    The Discussion (page unavailable) reports that the mortality association persisted for early enteral nutrition but not early parenteral nutrition in a propensity-weighted analysis. It does not establish a comparison of *full* EN with *full* PN; the authors explicitly caution against interpreting the result to mean that high-dose PN is safe while EN is not. (LLM, conf=0.86)

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  1. [1]Herridge MS Tansey CM Matté A Tomlinson G Diaz-Granados N Cooper A Functional disability 5 years after acute respiratory distress syndrome N Engl J Med 2011 364 1293 1304 21470008
  2. [3]Correia MITD Waitzberg DL The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis Clin Nutr 2003 22 235 239 12765661
  3. [4]Lew CCH Wong GJY Cheung KP Chua AP Chong MFF Miller M Association between malnutrition and 28-day mortality and intensive care length-of-stay in the critically ill: a prospective cohort study Nutrients 2017 10 10 29295506 PMC5793238
  4. [5]Jeong DH Hong SB Lim CM Koh Y Seo J Kim Y Relationship between nutrition intake and 28-day mortality using modified NUTRIC score in patients with sepsis Nutrients 2019 11 1906 31443186 PMC6723508
  5. [6]Aldridge K Donnelly K Johnston A Permissive underfeeding or standard enteral feeding in critically ill adults J Intensive Care Soc 2015 16 348 349 28979443 PMC5606471
  6. [7]Arabi YM Aldawood AS Haddad SH Al-Dorzi HM Tamim HM Jones G Permissive underfeeding or standard enteral feeding in critically ill adults N Engl J Med. 2015 372 2398 408 25992505
  7. [8]Arabi YM Tamim HM Dhar GS Al-Dawood A Al-Sultan M Sakkijha MH Permissive underfeeding and intensive insulin therapy in critically ill patients: a randomized controlled trial Am J Clin Nutr 2011 93 569 577 21270385
  8. [9]Charles EJ Petroze RT Metzger R Hranjec T Rosenberger LH Riccio LM Hypocaloric compared with eucaloric nutritional support and its effect on infection rates in a surgical intensive care unit: a randomized controlled trial Am J Clin Nutr 2014 100 1337 43 25332331 PMC4196484
  9. [10]Chelkeba L Mojtahedzadeh M Mekonnen Z Effect of calories delivered on clinical outcomes in critically ill patients: systemic review and meta-analysis Indian J Crit Care Med 2017 21 376 90 28701844 PMC5492740
  10. [11]Compher C Bingham AL McCall M Patel J Rice TW Braunschweig C Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition J Parenter Enter Nutr 2022 46 12 41 10.1002/jpen.2267 34784064 · DOI · Paper page
  11. [12]Allingstrup MJ Kondrup J Wiis J Claudius C Pedersen UG Hein-Rasmussen R Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial Intensive Care Med 2017 43 1637 1647 28936712
  12. [13]Kreymann KG Berger MM Deutz NEP Hiesmayr M Jolliet P Kazandjiev G ESPEN guidelines on enteral nutrition: intensive care Clin Nutr 2006 25 210 23 16697087
  13. [15]McClave SA Taylor BE Martindale RG Warren MM Johnson DR Braunschweig C Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) J Parenter Enter Nutr 2016 40 159 211 26773077
  14. [16]Padilla PF Martínez G Vernooij RWM Urrútia G Figuls MRI Cosp XB Early enteral nutrition (Within 48 hours) versus delayed enteral nutrition (after 48 hours) with or without supplemental parenteral nutrition in critically ill adults Cochrane Database Syst Rev 2019 10.1002/14651858.CD012340.pub2 PMC6820694 31684690 · DOI
  15. [18]Ortiz-Reyes L Patel JJ Jiang X Coz Yataco A Day AG Shah F Early versus delayed enteral nutrition in mechanically ventilated patients with circulatory shock: a nested cohort analysis of an international multicenter, pragmatic clinical trial Crit Care 2022 26 173 35681220 PMC9185884
  16. [20]Piton G Le Gouge A Boisramé-Helms J Anguel N Argaud L Asfar P Factors associated with acute mesenteric ischemia among critically ill ventilated patients with shock: a post hoc analysis of the NUTRIREA2 trial Intensive Care Med 2022 6 66 35190840
  17. [21]von Elm E Altman DG Egger M Pocock SJ Gøtzsche PC Vandenbroucke JP The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies Lancet 2007 370 1453 7 10.1016/S0140-6736(07)61602-X 18064739 · DOI · Paper page
  18. [22]Gall JR Lemeshow S Saulnier F A new Simplified Acute Physiology Score (SAPS II) based on a European/North American Multicenter Study J Am Med Assoc 1993 270 2957 2963 8254858
  19. [23]Vincent JL Moreno R Takala J Willatts S De Mendonça A Bruining H The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure Intensive Care Med 1996 66 707 10 8844239
  20. [24]Knaus WA Draper EA Wagner DP Zimmerman JE APACHE II: a severity of disease classification system Crit Care Med 1985 13 818 829 3928249
  21. [27]Bang H Robins JM Doubly robust estimation in missing data and causal inference models Biometrics 2005 61 962 73 10.1111/j.1541-0420.2005.00377.x 16401269 · DOI · Paper page
  22. [28]Singer P Cohen J Nutrition in the ICU: proof of the pudding is in the tasting Intensive Care Med 2015 41 154 156 25432421
  23. [29]Salciute-Simene E Stasiunaitis R Ambrasas E Tutkus J Milkevicius I Sostakaite G Impact of enteral nutrition interruptions on underfeeding in intensive care unit Clin Nutr 2021 40 1310 7 32896448
  24. [30]Kim H Stotts NA Froelicher ES Engler MM Porter C Why patients in critical care do not receive adequate enteral nutrition? A review of the literature J Crit Care 2012 27 702 713 23084129
  25. [31]Borel AL Schwebel C Planquette B Vésin A Garrouste-Orgeas M Adrie C Initiation of nutritional support is delayed in critically ill obese patients: a multicenter cohort study Am J Clin Nutr 2014 100 859 866 25080456
  26. [33]Segaran E Wandrag L Stotz M Terblanche M Hickson M Does body mass index impact on muscle wasting and recovery following critical illness? A pilot feasibility observational study J Hum Nutr Diet Off J Br Diet Assoc 2017 30 227 35 27477516
  27. [34]Goossens C Marques MB Derde S Vander Perre S Dufour T Thiessen SE Premorbid obesity, but not nutrition, prevents critical illness-induced muscle wasting and weakness J Cachexia Sarcopenia Muscle 2017 8 89 101 10.1002/jcsm.12131 27897405 PMC5326828 · DOI
  28. [35]Goossens C Weckx R Derde S Dufour T Vander Perre S Pauwels L Adipose tissue protects against sepsis-induced muscle weakness in mice: from lipolysis to ketones Crit Care 2019 10.1186/s13054-019-2506-6 31262340 PMC6600878 · DOI
  29. [36]Udin I Habisreutinger M Tappy L Schneider AG Berger MM Magnitude of gluconeogenesis and endogenous glucose production: Are they predictable in clinical settings? Clin Nutr 2021 40 3807 3814 34130027
  30. [37]Heidegger CP Berger MM Graf S Zingg W Darmon P Costanza MC Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial Lancet 2013 381 385 393 23218813
  31. [38]Kerklaan D Hulst JM Verhoeven JJ Verbruggen SCAT Joosten KFM Use of indirect calorimetry to detect overfeeding in critically ill children: finding the appropriate definition J Pediatr Gastroenterol Nutr 2016 63 445 50 26998927
  32. [39]Duan J-Y Tsinghua B Hospital C Zheng W-H Zhou H Xu Y Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis Crit Care 2021 6 66 10.21203/rs.3.rs-125406/v2 PMC7913168 33639997 · DOI
  33. [41]Vanhorebeek I Gunst J Derde S Derese I Boussemaere M Güiza F Insufficient activation of autophagy allows cellular damage to accumulate in critically ill patients J Clin Endocrinol Metab 2011 96 E633 E645 21270330
  34. [42]Gunst J Derese I Aertgeerts A Ververs E-J Wauters A Van den Berghe G Insufficient autophagy contributes to mitochondrial dysfunction, organ failure, and adverse outcome in an animal model of critical illness Crit Care Med 2013 41 182 194 23222264
  35. [43]Gunst J Recovery from critical illness-induced organ failure: the role of autophagy Crit Care 2017 21 209 28784175 PMC5547478
  36. [46]The National Heart and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network* L. Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA. 2012;307:795–803. 10.1001/jama.2012.137. PMC3743415 22307571 · DOI · Paper page
  37. [47]Heyland DK Dhaliwal R Jiang X Day AG Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool Crit Care 2011 15 R268 22085763 PMC3388687
  38. [48]Arabi YM Aldawood AS Al-Dorzi HM Tamim HM Haddad SH Jones G Permissive underfeeding or standard enteral feeding in high-and low-nutritional-risk critically ill adults Am J Respir Crit Care Med 2017 195 652 62 27589411
  39. [49]Stoppe C Wendt S Mehta NM Compher C Preiser J-C Heyland DK Biomarkers in critical care nutrition Crit Care 2020 24 499 10.1186/s13054-020-03208-7 32787899 PMC7425162 · DOI
  40. [51]Servia-Goixart L Lopez-Delgado JC Grau-Carmona T Trujillano-Cabello J Bordeje-Laguna ML Mor-Marco E Evaluation of nutritional practices in the critical care patient (The ENPIC study): Does nutrition really affect ICU mortality? Clin Nutr ESPEN 2022 47 325 332 35063222
  41. [52]Shaw JHF Wildbore M Wolfe RR Whole body protein kinetics in severely septic patients. The response to glucose infusion and total parenteral nutrition Ann Surg 1987 205 288 94 3103555 PMC1492705
  42. [53]Chapple L-AS van Gassel RJJ Rooyackers O Protein metabolism in critical illness Curr Opin Crit Care 2022 28 367 73 35792908
  43. [54]Koekkoek WAC (Kristine., van Setten CH (Coralien., Olthof LE, Kars JCN (Hans., van Zanten ARH. Timing of PROTein INtake and clinical outcomes of adult critically ill patients on prolonged mechanical VENTilation: the PROTINVENT retrospective study. Clin Nutr 2019;38:883–90. 29486907
  44. [55]Vanhorebeek I Verbruggen S Casaer MP Gunst J Wouters PJ Hanot J Effect of early supplemental parenteral nutrition in the paediatric ICU: a preplanned observational study of post-randomisation treatments in the PEPaNIC trial Lancet Respir Med 2017 5 475 483 28522351
  45. [56]Reignier J Le Gouge A Lascarrou JB Annane D Argaud L Hourmant Y Impact of early low-calorie low-protein versus standard-calorie standard-protein feeding on outcomes of ventilated adults with shock: design and conduct of a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3) BMJ Open 2021 66 11 PMC8117996 33980526
  46. [57]McClave SA Codner P Patel J Hurt RT Allen K Martindale RG Should we aim for full enteral feeding in the first week of critical illness? Nutr Clin Pract Off Publ Am Soc Parenter Enter Nutr 2016 31 425 431 27317613
  47. [58]Hollinger A Gayat E Féliot E Paugam-Burtz C Fournier M-C Duranteau J Gender and survival of critically ill patients: results from the FROG-ICU study Ann Intensive Care 2019 9 43 10.1186/s13613-019-0514-y 30927096 PMC6441070 · DOI
  48. [59]Jarden RJ Sutton-Smith L Boulton C Oral intake evaluation in patients following critical illness: an ICU cohort study Nurs Crit Care 2018 23 179 85 29659093
  49. [60]Peterson SJ Tsai AA Scala CM Sowa DC Sheean PM Braunschweig CL Adequacy of oral intake in critically ill patients 1 week after extubation J Am Diet Assoc 2010 110 427 433 20184993
  50. [61]Moisey LL Pikul J Keller H Yeung CYE Rahman A Heyland DK Adequacy of protein and energy intake in critically ill adults following liberation from mechanical ventilation is dependent on route of nutrition delivery Nutr Clin Pract 2021 36 201 12 10.1002/ncp.10558 32717141 · DOI
  51. [62]Kondrup J Ramussen HH Hamberg O Stanga Z Camilo M Richardson R Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials Clin Nutr 2003 66 321 36 12765673
  52. [63]Lew CCH Wong GJY Cheung KP Fraser RJL Chua AP Chong MFF The association between nutritional adequacy and 28-day mortality in the critically ill is not modified by their baseline nutritional status and disease severity Crit Care 2019 23 222 10.1186/s13054-019-2500-z 31215498 PMC6580600 · DOI
  53. [64]Reintam Blaser A Padar M Mändul M Elke G Engel C Fischer K Development of the Gastrointestinal Dysfunction Score (GIDS) for critically ill patients—a prospective multicenter observational study (iSOFA study) Clin Nutr 2021 40 4932 40 34358839
  54. [65]Preiser JC Arabi YM Berger MM Casaer M McClave S Montejo-González JC A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice Crit Care 2021 25 1 13 10.1186/s13054-021-03847-4 34906215 PMC8669237 · DOI · Paper page
  55. [66]Berger MM Reintam-Blaser A Calder PC Casaer M Hiesmayr MJ Mayer K Monitoring nutrition in the ICU Clin Nutr 2019 38 584 593 30077342
  56. [67]Soguel L Revelly JP Schaller MD Longchamp C Berger MM Energy deficit and length of hospital stay can be reduced by a two-step quality improvement of nutrition therapy: the intensive care unit dietitian can make the difference Crit Care Med 2012 40 412 9 21926572
  57. [68]Derouin E Picard G Kerever S Dieticians’ practices in intensive care: a national survey Clin Nutr ESPEN 2021 45 245 51 34620324
  58. [69]Needham DM Feldman DR Kho ME The functional costs of ICU survivorship: collaborating to improve post-ICU disability Am J Respir Crit Care Med 2011 15 183 962 964 21498817
  59. [70]Ridley EJ Parke RL Davies AR Bailey M Hodgson C Deane AM What happens to nutrition intake in the post-intensive care unit hospitalization period? An observational cohort study in critically ill adults J Parenter Enter Nutr. 2019 43 88 95 29924393
  60. [71]Davies TW van Gassel RJJ van de Poll M Gunst J Casaer MP Christopher KB Core outcome measures for clinical effectiveness trials of nutritional and metabolic interventions in critical illness: an international modified Delphi consensus study evaluation (CONCISE) Crit Care 2022 26 240 10.1186/s13054-022-04113-x 35933433 PMC9357332 · DOI
  61. [72]Ridley EJ, Bailey M, Chapman M, Chapple L-AS, Deane AM, Hodgson C, et al. Protocol summary and statistical analysis plan for Intensive Nutrition Therapy comparEd to usual care iN criTically ill adults (INTENT): a phase II randomised controlled trial. BMJ Open. 2022;12:050153. PMC8905937 35260448
  62. [73]Toulouse E Lafont B Granier S Mcgurk G Bazin JE French legal approach to patient consent in clinical research Anaesth Crit Care Pain Med 2020 66 883 5 33130015

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Authors
Pardo, E., Lescot, T., Preiser, J.-C., Massanet, P., Pons, A., Jaber, S., Fraipont, V., Levesque, E., Ichai, C., Petit, L., Tamion, F., Taverny, G., Boizeau, P., Alberti, C., Constantin, J.-M., Bonnet, M.-P., the FRANS study group, Samba, D., Moyer, J.-D., Montravers, P., Mongardon, N., Meffert, A., De Jong, A., Belafia, F., Morel, J., Asehnoune, K., Mahé, P.-J., D’Hondt, A., Paquot, N., Leone, M., Kaidomar, M., Grech, L., Gouteix, E., Barsam, E., Duranteau, J., & Martinez, O.
Affiliations
  • Sorbonne Université (FR)
  • Université Libre de Bruxelles (BE)
  • Centre Hospitalier Universitaire de Nîmes (FR)
  • Centre National de la Recherche Scientifique (FR)
  • Centre hospitalier régional de la Citadelle (BE)
  • Hôpital Pellegrin (FR)
  • Inserm (FR)
  • Assistance Publique – Hôpitaux de Paris (FR)
Corresponding author
Pardo, Emmanuel
ORCID
Venue
Critical Care
Publisher
Springer Science and Business Media LLC
Published
2023-01-07
Volume
27
Issue
1
Pages
7-7
ISSN
1364-8535 (ISSN-L)
DOI
10.1186/s13054-022-04298-1
PMC
PMC9826592
OpenAlex
W4313682073
Cited by
116
References
9
Citations by year
2026: 21 · 2025: 28 · 2024: 48 · 2023: 18 · 2016: 1
FWCI
20.36
Type
journal article
Language
en
Open access
Licence
Locations
  • Critical Care (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • HAL (submittedVersion, other-oa)
  • Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion, other-oa)
  • Open Repository and Bibliography (University of Liège) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Baxter International
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Keywords
critically ill patients, 28-day mortality, enteral nutrition, parenteral nutrition, multiple organ failure, SOFA score, obesity, young patients, dietary guidelines, critically ill adults, ICU length of stay, mortality risk factors
MeSH terms
Adult, Humans, Intensive Care Units, Length of Stay, Nutritional Status, Prospective Studies, Cohort Studies, Critical Illness, Nutritional Support

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