Department of Clinical Nutrition, Chikamori Hospital, Japan; Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Japan.
Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Japan.
Clin Nutr. 2020 Jan;39(1):174-179. doi: 10.1016/j.clnu.2019.01.010. Epub 2019 Jan 22.
BACKGROUND & AIMS: The effect of nutrition support therapy on prevention of readmission among patients with acute heart failure (HF) in an intensive care unit (ICU) setting remains unclear. We hypothesized that nutrition support therapy might decrease the readmission rate among these patients. Thus, we conducted a single-center prospective observational study to verify this hypothesis.
Patients diagnosed with acute HF admitted to the ICU for more than 14 days between April 2016 and March 2017 were included in the analysis. The primary outcome was the relationship between nutritional intake and HF-related hospital readmission due to HF at 180 days after discharge. We divided the participants into 2 groups: patients who were not readmitted to hospital within 180 days after discharge (non-readmission group) and patients who were readmitted within this timeframe (HF-related readmission group). Data were expressed as median (interquartile range).
Sixty patients required readmission due to HF-related events (HF-related readmission group). On the other hand, 127 patients did not require readmission (non-readmission group). The calorie and protein intake on day 3 after ICU admission in the HF-related readmission group was significantly higher than that in the non-readmission group [20.5 (14.2, 27.8) vs. 27.7 (22.5, 31.2) kcal/kg/day, p < 0.001; 0.7 (0.5, 0.9) vs. 0.9 (0.7, 1.2) g/kg/day, p < 0.001, respectively]. Similarly, the protein intake values on day 7 were also significantly higher in the HF-related readmission group [0.8 (0.6, 1.0) vs. 0.9 (0.7, 1.2) g/kg/day, p = 0.04]. Multivariate analysis indicated that total caloric intake on day 3 was an independent factor affecting readmission (odds ratio = 1.05, 95% confidence interval = 1.01-1.09, p = 0.006). In addition, when the cut off value of calorie intake was set to 18 kcal/kg/day, the group ingesting ≥18 kcal/kg/day on day 3 had a significantly higher readmission rate within 180 days after discharge.
Our data showed that total calorie intake ≥18 kcal/kg/day on day 3 might increase the readmission rate among patients with acute HF.
营养支持疗法对 ICU 中急性心力衰竭（HF）患者再入院的预防效果尚不清楚。我们假设营养支持疗法可能会降低这些患者的再入院率。因此，我们进行了一项单中心前瞻性观察研究来验证这一假设。
纳入 2016 年 4 月至 2017 年 3 月期间因急性 HF 入住 ICU 超过 14 天的患者进行分析。主要结局为出院后 180 天内营养摄入与 HF 相关的 HF 再入院之间的关系。我们将参与者分为两组：出院后 180 天内未再次住院的患者（非再入院组）和在此时间段内再次住院的患者（HF 相关再入院组）。数据表示为中位数（四分位距）。
60 例患者因 HF 相关事件需要再次入院（HF 相关再入院组）。另一方面，127 例患者无需再次入院（非再入院组）。HF 相关再入院组患者在 ICU 入院后第 3 天的热量和蛋白质摄入量明显高于非再入院组[20.5（14.2，27.8）比 27.7（22.5，31.2）kcal/kg/天，p<0.001；0.7（0.5，0.9）比 0.9（0.7，1.2）g/kg/天，p<0.001]。同样，HF 相关再入院组患者在第 7 天的蛋白质摄入量也明显较高[0.8（0.6，1.0）比 0.9（0.7，1.2）g/kg/天，p=0.04]。多变量分析表明，第 3 天的总热量摄入是影响再入院的独立因素（比值比=1.05，95%置信区间=1.01-1.09，p=0.006）。此外，当将热量摄入的截止值设定为 18 kcal/kg/天时，第 3 天摄入≥18 kcal/kg/天的组在出院后 180 天内的再入院率明显更高。
我们的数据表明，第 3 天的总热量摄入≥18 kcal/kg/天可能会增加急性 HF 患者的再入院率。
