Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium.
Intensive Care Med. 2024 Oct;50(10):1593-1602. doi: 10.1007/s00134-024-07546-w. Epub 2024 Jul 17.
In critically ill adults, withholding parenteral nutrition until 1 week after intensive care admission (Late-PN) facilitated recovery as compared with early supplementation of insufficient enteral nutrition with parenteral nutrition (Early-PN). However, the impact on long-term mortality and functional outcome, in relation to the estimated nutritional risk, remains unclear.
In this prospective follow-up study of the multicenter EPaNIC randomized controlled trial, we investigated the impact of Late-PN on 2-year mortality (N = 4640) and physical functioning, assessed by the 36-Item Short Form Health Survey (SF-36; in 3292 survivors, responding 819 [738-1058] days post-randomization). To account for missing data, we repeated the analyses in two imputed models. To identify potential heterogeneity of treatment effects, we investigated the impact of Late-PN in different nutritional risk subgroups as defined by Nutritional Risk Screening-2002-score, modified NUTrition Risk in the Critically Ill-score, and age (above/below 70 years), and we evaluated whether there was statistically significant interaction between classification to a nutritional risk subgroup and the effect of the randomized intervention. Secondary outcomes were SF-36-derived physical and mental component scores (PCS & MCS).
Two-year mortality (20.5% in Late-PN, 19.8% in Early-PN; P = 0.54) and physical functioning (70 [40-90] in both study-arms; P = 0.99) were similar in both groups, also after imputation of missing physical functioning data. Likewise, Late-PN had no impact on 2-year mortality and physical functioning in any nutritional risk subgroup. PCS and MCS were similar in both groups.
Late-PN did not alter 2-year survival and physical functioning in adult critically ill patients, independent of anticipated nutritional risk.
与早期给予肠内营养不足时补充肠外营养（早期肠外营养，Early-PN）相比，在重症监护病房入住后 1 周内停止给予肠外营养（晚期肠外营养，Late-PN）可促进危重症成人的康复。然而，与预计的营养风险相关的长期死亡率和功能结局的影响仍不清楚。
在多中心 EPaNIC 随机对照试验的前瞻性随访研究中，我们调查了 Late-PN 对 2 年死亡率（N=4640）和身体功能的影响，身体功能通过 36 项简短健康调查（SF-36；在 3292 名幸存者中，随机分组后 819[738-1058]天进行评估）。为了处理缺失数据，我们在两个插补模型中重复了分析。为了确定治疗效果的潜在异质性，我们根据营养风险筛查 2002 评分、改良的危重患者营养风险评分以及年龄（70 岁以上/以下）定义的不同营养风险亚组，调查了 Late-PN 的影响，并评估了分类到营养风险亚组与随机干预效果之间是否存在统计学显著的交互作用。次要结局为 SF-36 衍生的生理和心理成分评分（PCS 和 MCS）。
2 年死亡率（Late-PN 组为 20.5%，Early-PN 组为 19.8%；P=0.54）和身体功能（两组均为 70[40-90]；P=0.99）在两组中相似，在缺失身体功能数据的插补后也相似。同样，Late-PN 对任何营养风险亚组的 2 年死亡率和身体功能均无影响。PCS 和 MCS 在两组中相似。
晚期肠外营养并未改变成年重症患者 2 年的生存率和身体功能，与预期的营养风险无关。
