Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
PINC AI™ Applied Sciences, Applied Research, Premier Inc., Charlotte, North Carolina, United States of America.
PLoS One. 2024 Apr 26;19(4):e0302074. doi: 10.1371/journal.pone.0302074. eCollection 2024.
Arginine-supplemented enteral immunonutrition has been designed to optimize outcomes in critical care patients. Existing formulas may be isocaloric and isoproteic, yet differ in L-arginine content, energy distribution, and in source and amount of many other specialized ingredients. The individual contributions of each may be difficult to pinpoint; however, all cumulate in the body's response to illness and injury. The study objective was to compare health outcomes between different immunonutrition formulas.
Real-world data from October 2015 -February 2019 in the PINC AI™ Healthcare Database (formerly the Premier Healthcare Database) was reviewed for patients with an intensive care unit (ICU) stay and ≥3 days exclusive use of either higher L-arginine formula (HAF), or lower L-arginine formula (LAF). Multivariable generalized linear model regression was used to check associations between formulas and ICU length of stay.
3,284 patients (74.5% surgical) were included from 21 hospitals, with 2,525 receiving HAF and 759 LAF. Inpatient mortality (19.4%) and surgical site infections (6.2%) were similar across groups. Median hospital stay of 17 days (IQR: 16) did not differ by immunonutrition formula. Median ICU stay was shorter for patients receiving HAF compared to LAF (10 vs 12 days; P<0.001). After adjusting for demographics, visit, severity of illness, and other clinical characteristics, associated regression-adjusted ICU length of stay for patients in the HAF group was 11% shorter [0.89 (95% CI: 0.84, 0.94; P<0.001)] compared to patients in the LAF group. Estimated adjusted mean ICU length of stay was 9.4 days (95% CI: 8.9, 10.0 days) for the HAF group compared to 10.6 days (95% CI: 9.9, 11.3 days) for the LAF group (P<0.001).
Despite formulas being isocaloric and isoproteic, HAF use was associated with significantly reduced ICU length of stay, compared to LAF. Higher arginine immunonutrition formula may play a role in improving health outcomes in primarily surgical critically ill patients.
精氨酸强化的肠内免疫营养旨在优化重症监护患者的治疗效果。现有的配方可能具有相同的热量和蛋白质含量，但在精氨酸含量、能量分布以及许多其他特殊成分的来源和数量上有所不同。每个成分的单独贡献可能难以确定；然而，所有这些成分都会累积在机体对疾病和损伤的反应中。本研究的目的是比较不同免疫营养配方对患者健康结局的影响。
回顾 2015 年 10 月至 2019 年 2 月期间 PINC AI 医疗保健数据库（原 Premier 医疗保健数据库）中 ICU 入住时间≥3 天的患者真实世界数据，且 ICU 期间患者均接受肠内营养支持，其中使用高精氨酸配方（HAF）的患者有 2525 例，使用低精氨酸配方（LAF）的患者有 759 例。采用多变量广义线性模型回归分析评估患者 ICU 入住时间与不同配方之间的关系。
共纳入来自 21 家医院的 3284 例（74.5%为外科手术患者），其中 2525 例接受 HAF，759 例接受 LAF。两组患者的院内死亡率（19.4%）和手术部位感染率（6.2%）相似。17 天（IQR：16）的中位住院时间不因免疫营养配方而异。与 LAF 相比，接受 HAF 的患者 ICU 入住时间更短（10 天 vs 12 天；P<0.001）。在调整人口统计学、就诊、疾病严重程度和其他临床特征后，与 LAF 组相比，HAF 组患者 ICU 入住时间的校正回归调整 ICU 住院时间缩短 11%[0.89（95%CI：0.84，0.94；P<0.001)]。HAF 组估计的校正平均 ICU 住院时间为 9.4 天（95%CI：8.9，10.0 天），LAF 组为 10.6 天（95%CI：9.9，11.3 天）（P<0.001）。
尽管配方的热量和蛋白质含量相同，但与 LAF 相比，使用 HAF 可显著缩短 ICU 入住时间。高精氨酸免疫营养配方可能在改善主要为外科手术的重症患者的健康结局方面发挥作用。
