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 Dec 24;16(1):57. doi: 10.3390/nu16010057.
Some critically ill patients completely rely on parenteral nutrition (PN), which often cannot provide sufficient energy/amino acids. We investigated the relationship between PN doses of energy/amino acids and clinical outcomes in a retrospective cohort study using a medical claims database (≥10.5 years, from Japan, and involving 20,773 adult intensive care unit (ICU) patients on mechanical ventilation and exclusively receiving PN). Study patients: >70 years old, 63.0%; male, 63.3%; and BMI < 22.5, 56.3%. Initiation of PN: third day of ICU admission. PN duration: 12 days. In-hospital mortality: 42.5%. Patients were divided into nine subgroups based on combinations of the mean daily doses received during ICU days 4-7: (1) energy (very low <10 kcal/kg/day; low ≥10, <20; and moderate ≥20); (2) amino acids (very low <0.3 g/kg/day; low ≥0.3, <0.6; and moderate ≥0.6). For each subgroup, adjusted odds ratios (AORs) of in-hospital mortality with 95% confidence intervals (CIs) were calculated by regression analysis. The highest odds of mortality among the nine subgroups was in the moderate calorie/very low amino acid (AOR = 2.25, 95% CI 1.76-2.87) and moderate calorie/low amino acid (AOR = 1.68, 95% CI 1.36-2.08) subgroups, meaning a significant increase in the odds of mortality by between 68% and 125% when an amino acid dose of <0.6 g/kg/day was prescribed during ICU days 4-7, even when ≥20 kcal/kg/day of calories was prescribed. In conclusion, PN-dependent critically ill patients may have better outcomes including in-hospital mortality when ≥0.6 g/kg/day of amino acids is prescribed.
一些危重症患者完全依赖肠外营养（PN），但 PN 往往无法提供足够的能量/氨基酸。我们使用医疗索赔数据库进行了一项回顾性队列研究，调查了能量/氨基酸 PN 剂量与临床结局之间的关系（≥10.5 年，来自日本，涉及 20773 名接受机械通气且仅接受 PN 的成年重症监护病房（ICU）患者）。研究患者：>70 岁，63.0%；男性，63.3%；BMI<22.5，56.3%。PN 起始时间：入住 ICU 第 3 天。PN 持续时间：12 天。院内死亡率：42.5%。根据 ICU 第 4-7 天接受的平均每日剂量，患者分为 9 个亚组：（1）能量（极低<10 kcal/kg/天；低≥10，<20；中≥20）；（2）氨基酸（极低<0.3 g/kg/天；低≥0.3，<0.6；中≥0.6）。对于每个亚组，通过回归分析计算调整后的住院死亡率比值比（AOR）及其 95%置信区间（CI）。9 个亚组中，死亡率最高的是中热量/低氨基酸（AOR=2.25，95%CI 1.76-2.87）和中热量/低氨基酸（AOR=1.68，95%CI 1.36-2.08）亚组，这意味着 ICU 第 4-7 天每天给予<0.6 g/kg/天的氨基酸时，死亡率的几率增加了 68%至 125%。即使给予≥20 kcal/kg/天的热量时，也是如此。总之，当给予≥0.6 g/kg/天的氨基酸时，依赖 PN 的危重症患者可能会有更好的结局，包括院内死亡率。
