Critical Care Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, 90035-003, Porto Alegre, RS, Brazil.
Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Rua Ramiro Barcelos 2400, 90035-003, Porto Alegre, RS, Brazil.
Clin Nutr. 2020 Mar;39(3):935-941. doi: 10.1016/j.clnu.2019.03.038. Epub 2019 Apr 5.
BACKGROUND & AIMS: Critically ill patients with body mass index (BMI) < 20 kg/m have worse outcomes than normal/overweight patients possibly because underweight is a marker of malnutrition. To assess the effects of nutrition therapy in this population during the first week of an ICU stay.
Prospective, 2-centre, observational study. Nutritional evaluations were performed between days 2 and 3 (first) and between days 5 and 7 (second) of ICU admission. In the first evaluation, patients were divided into non-fed (without nutritional support) and early-fed (those already receiving nutritional support) groups. In the second evaluation, patients were divided according to caloric intake (≥or<20 kcal/kg) and protein intake (≥or<1.3 g of protein/kg).
Of the 4236 patients screened and 342 were included in the cohort. Mortality was 58.5% (median 21 [11-38.25] days of follow-up). Unadjusted patient survival was worse in the non-fed group than in the early-fed group (HR 1.66; 95%CI, 1.18 to 2.32). There was no difference in mortality between groups after adjusting for the SOFA score on the day of the evaluation. At the second evaluation, unadjusted analysis showed better in-hospital survival in patients with higher caloric (HR0.58; 95%CI, 0.40 to 0.86) and protein intake (HR0.59; 95%CI, 0.42 to 0.82); there was no association between mortality and caloric or protein intake after adjusting for the SOFA score on the day of the evaluation.
Nutritional therapy in the first week of ICU stay did not affect vital outcome after adjusting for the SOFA score on the day of the evaluation in underweight critically ill patients.
ClinicalTrials.gov number NCT03398343.
身体质量指数（BMI）<20kg/m²的危重症患者的预后比正常/超重患者差，这可能是因为体重过轻是营养不良的标志。本研究旨在评估 ICU 入住的第一周内对该人群进行营养治疗的效果。
前瞻性、2 中心、观察性研究。营养评估在 ICU 入住第 2-3 天（第 1 次）和第 5-7 天（第 2 次）进行。在第 1 次评估中，患者被分为未喂养（无营养支持）和早期喂养（已接受营养支持）组。在第 2 次评估中，患者根据热量摄入（≥或<20kcal/kg）和蛋白质摄入（≥或<1.3g/kg）进行分组。
在筛选的 4236 名患者中，有 342 名被纳入队列。死亡率为 58.5%（中位随访时间为 21[11-38.25]天）。未经调整的患者生存率在未喂养组低于早期喂养组（HR 1.66；95%CI，1.18 至 2.32）。调整评估日 SOFA 评分后，两组间死亡率无差异。在第 2 次评估中，未经调整的分析显示热量摄入较高的患者住院生存率更高（HR0.58；95%CI，0.40 至 0.86）和蛋白质摄入（HR0.59；95%CI，0.42 至 0.82）；调整评估日 SOFA 评分后，死亡率与热量或蛋白质摄入无关。
在调整评估日 SOFA 评分后，营养治疗在 ICU 入住的第一周内并未影响体重过轻的危重症患者的生存结局。
ClinicalTrials.gov 编号 NCT03398343。
