Fan Xing, Chen Lei, Zhang Ying, Liu Jing, Zhu Chuangqi, Wang Yingchun
Department of Critical Care Medicine, Ezhou Central Hospital, Ezhou, Hubei, China.
Department of Gastrointestinal Surgery, Ezhou Central Hospital, Ezhou, Hubei, China.
Medicine (Baltimore). 2025 Sep 12;104(37):e44343. doi: 10.1097/MD.0000000000044343.
This single-center retrospective study investigates the effect of the timing of enteral nutrition (EN) initiation on the prognosis of critically ill patients with abdominal infection and provide evidence for clinical nutrition support strategies. A total of 76 patients with abdominal infections who were admitted to the intensive care unit (ICU) of our hospital from January 2023 to December 2024 were included. The patients were divided into 2 groups based on the timing of EN initiation: the early EN group (≤48 hours, n = 42) and the delayed EN group (>48 hours, n = 34). Data on demographic characteristics, disease severity scores, infection types, nutritional intake, EN-related complications, and clinical outcomes were collected. The differences in 28-day mortality, ICU length of stay, infection control time, and nutritional adequacy between the 2 groups were compared. A logistic regression model was used to analyze the independent effect of EN initiation timing on 28-day mortality, and subgroup analysis was performed to explore the prognostic effect of EN initiation timing in different clinical contexts. There were no statistically significant differences in the baseline characteristics between the 2 groups, making them comparable. Compared to the delayed EN group, the early EN group had a lower 28-day mortality (19.0% vs 35.3%, P = .048), shorter ICU length of stay (10.8 ± 4.2 vs 13.6 ± 5.1 days, P = .011), shorter infection control time (4.8 ± 1.5 vs 6.3 ± 2.1 days, P = .002), and faster C-reactive protein recovery (5.6 ± 1.9 vs 7.4 ± 2.2 days, P = .001), with more adequate and faster nutritional intake. Logistic regression analysis showed that delayed EN initiation was an independent risk factor for 28-day mortality (odds ratios = 2.51, 95% confidence interval: 1.09-5.82, P = .030). Subgroup analysis suggested that early EN provided a more significant survival benefit in patients with an APACHE II score ≥ 20 or those requiring mechanical ventilation (interaction P values of .041 and .049, respectively). For critically ill patients with abdominal infections, early initiation of EN helps improve nutritional status, accelerate infection control, and reduce 28-day mortality, especially in patients with more severe conditions or those requiring mechanical ventilation, where the prognosis is improved more significantly. The timing of EN initiation should be emphasized in critical care nutrition support.
这项单中心回顾性研究探讨了肠内营养（EN）开始时间对腹部感染重症患者预后的影响，并为临床营养支持策略提供依据。纳入了2023年1月至2024年12月期间入住我院重症监护病房（ICU）的76例腹部感染患者。根据EN开始时间将患者分为2组：早期EN组（≤48小时，n = 42）和延迟EN组（>48小时，n = 34）。收集了人口统计学特征、疾病严重程度评分、感染类型、营养摄入、EN相关并发症和临床结局的数据。比较了两组之间28天死亡率、ICU住院时间、感染控制时间和营养充足率的差异。使用逻辑回归模型分析EN开始时间对28天死亡率的独立影响，并进行亚组分析以探讨EN开始时间在不同临床背景下的预后影响。两组之间的基线特征无统计学显著差异，具有可比性。与延迟EN组相比，早期EN组的28天死亡率较低（19.0%对35.3%，P = .048），ICU住院时间较短（10.8±4.2对13.6±5.1天，P = .011），感染控制时间较短（4.8±1.5对6.3±2.1天，P = .002），C反应蛋白恢复更快（5.6±1.9对7.4±2.2天，P = .001），营养摄入更充足且更快。逻辑回归分析表明，延迟开始EN是28天死亡率的独立危险因素（比值比 = 2.51，95%置信区间：1.09 - 5.82，P = .030）。亚组分析表明，早期EN在急性生理与慢性健康状况评分系统II（APACHE II）评分≥20的患者或需要机械通气的患者中提供了更显著的生存益处（交互P值分别为.041和.049）。对于腹部感染重症患者，早期开始EN有助于改善营养状况、加速感染控制并降低28天死亡率，尤其是在病情更严重或需要机械通气的患者中，预后改善更为显著。在重症监护营养支持中应强调EN开始的时间。
