Department of Cardiovascular Surgery, People's Liberation Army The General Hospital of Western Theater Command, Chengdu, Sichuan, China.
Yonsei Med J. 2023 Apr;64(4):259-268. doi: 10.3349/ymj.2022.0276.
We aimed to analyze the optimal timing of enteral nutrition (EN) in the treatment of sepsis and its effect on sepsis-associated acute kidney injury (SA-AKI.).
The MIMIC-III database was employed to identify patients with sepsis who had received EN. With AKI as the primary outcome variable, receiver operating characteristic (ROC) curves were utilized to calculate the optimal cut-off time of early EN (EEN). Propensity score matching (PSM) was employed to control confounding effects. Logistic regressions and propensity score-based inverse probability of treatment weighting were utilized to assess the robustness of our findings. Comparisons within the EEN group were performed.
2364 patients were included in our study. With 53 hours after intensive care units (ICU) admission as the cut-off time of EEN according to the ROC curve, 1212 patients were assigned to the EEN group and the other 1152 to the delayed EN group. The risk of SA-AKI was reduced in the EEN group (odds ratio 0.319, 95% confidence interval 0.245-0.413, <0.001). The EEN patients received fewer volumes (mL) of intravenous fluid (IVF) during their ICU stay (3750 mL vs. 5513.23 mL, <0.001). The mediating effect of IVF was significant (<0.001 for the average causal mediation effect). No significant differences were found within the EEN group (0-48 hours vs. 48-53 hours), except that patients initiating EN within 48 hours spent fewer days in ICU and hospital.
EEN is associated with decreased risk of SA-AKI, and this beneficial effect may be proportionally mediated by IVF volume.
本研究旨在分析肠内营养（EN）治疗脓毒症的最佳时机及其对脓毒症相关急性肾损伤（SA-AKI）的影响。
利用 MIMIC-III 数据库，筛选出接受 EN 治疗的脓毒症患者。以 AKI 为主要结局变量，绘制受试者工作特征（ROC）曲线计算早期肠内营养（EEN）的最佳起始时间。采用倾向评分匹配（PSM）控制混杂因素。采用 logistic 回归和倾向评分逆概率处理加权（Inverse Probability of Treatment Weighting， IPTW）评估结果的稳健性。并对 EEN 组内进行比较。
本研究共纳入 2364 例患者。根据 ROC 曲线，以入住 ICU 53 小时作为 EEN 的截止时间，将 1212 例患者分为 EEN 组，其余 1152 例患者分为延迟 EN 组。EEN 组的 SA-AKI 风险降低（比值比 0.319，95%置信区间 0.245-0.413，<0.001）。EEN 组患者 ICU 期间接受的静脉输液量（mL）更少（3750 mL 比 5513.23 mL，<0.001）。静脉输液量的中介效应显著（平均因果中介效应<0.001）。EEN 组内（0-48 小时与 48-53 小时）除了起始 EN 时间在 48 小时内的患者 ICU 和住院天数更少外，无显著差异。
EEN 可降低 SA-AKI 风险，这种有益效果可能与静脉输液量呈比例相关。
