Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Ohmiya-ku, Saitama 330-0834, Japan.
Medical Affairs Department, Research and Development Center, Otsuka Pharmaceutical Factory, Inc., 2-9 Kandatsukasa-machi, Chiyoda-ku, Tokyo 101-0048, Japan.
Nutrients. 2023 Jun 19;15(12):2797. doi: 10.3390/nu15122797.
Guidelines for the nutritional management of critically ill patients recommend the use of injectable lipid emulsion (ILE) as part of parenteral nutrition (PN). The ILE's impact on outcomes remains unclear. Associations between prescribed ILE and in-hospital mortality, hospital readmission, and hospital length of stay (LOS) in critically ill patients in the intensive care unit (ICU) were investigated. Patients who were ≥18 years old in an ICU from January 2010 through June 2020, receiving mechanical ventilation, and fasting for >7 days, were selected from a Japanese medical claims database and divided, based on prescribed ILE during days from 4 to 7 of ICU admission, into 2 groups, no-lipid and with-lipid. Associations between the with-lipid group and in-hospital mortality, hospital readmission, and hospital LOS were evaluated relative to the no-lipid group. Regression analyses and the Cox proportional hazards model were used to calculate the odds ratios (OR) and regression coefficients, and hazard ratios (HR) were adjusted for patient characteristics and parenteral energy and amino acid doses. A total of 20,773 patients were evaluated. Adjusted OR and HR (95% confidence interval) for in-hospital mortality were 0.66 (0.62-0.71) and 0.68 (0.64-0.72), respectively, for the with-lipid group relative to the no-lipid group. No significant differences between the two groups were observed for hospital readmission or hospital LOS. The use of ILE for days 4 to 7 in PN prescribed for critically ill patients, who were in an ICU receiving mechanical ventilation and fasting for more than 7 days, was associated with a significant reduction in in-hospital mortality.
指南建议在肠外营养（PN）中使用注射用脂肪乳剂（ILE）。然而，ILE 对结局的影响仍不清楚。本研究旨在探讨 ICU 中接受机械通气和禁食>7 天的危重症患者，在 PN 中第 4-7 天处方 ILE 与院内死亡率、再入院率和住院时间（LOS）之间的关系。
从日本医疗索赔数据库中选择 2010 年 1 月至 2020 年 6 月期间 ICU 中≥18 岁、接受机械通气和禁食>7 天的患者，并根据 ICU 入院第 4-7 天期间处方 ILE 的情况，将患者分为无脂肪组和有脂肪组。评估有脂肪组与无脂肪组的院内死亡率、再入院率和 LOS 之间的关系。回归分析和 Cox 比例风险模型用于计算比值比（OR）和回归系数，调整患者特征和肠外能量及氨基酸剂量后计算风险比（HR）。共评估了 20773 例患者。调整后的 OR 和 HR（95%置信区间）分别为 0.66（0.62-0.71）和 0.68（0.64-0.72），有脂肪组与无脂肪组相比，院内死亡率降低。两组之间的再入院率或 LOS 无显著差异。对于接受机械通气和禁食>7 天的 ICU 危重症患者，PN 中第 4-7 天使用 ILE 与院内死亡率显著降低相关。
