Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study
Emmanuel Pardo,
Thomas Lescot,
Jean-Charles Preiser,
Pablo Massanet,
Antoine Pons,
Samir Jaber,
Vincent Fraipont,
Eric Levesque,
Carole Ichai,
Laurent Petit,
Fabienne Tamion,
Garry Taverny,
Priscilla Boizeau,
Corinne Alberti,
Jean-Michel Constantin,
Marie-Pierre Bonnet,
the FRANS study group
Affiliations
Emmanuel Pardo
Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d’Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance publique-hôpitaux de Paris
Thomas Lescot
Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d’Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance publique-hôpitaux de Paris
Jean-Charles Preiser
Service des Soins intensifs, Hôpital Erasme, Université Libre de Bruxelles
Pablo Massanet
Département Anesthésie-Réanimation, Centre Hospitalier Universitaire Nîmes
Antoine Pons
Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d’Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris
Samir Jaber
Department of Anaesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier. PhyMedExp, INSERM U1046, CNRS UMR
Vincent Fraipont
Service de Soins Intensifs, Centre Hospitalier Régional de Liège
Eric Levesque
Service d’anesthésie-réanimation chirurgicale, GHU Henri-Mondor
Carole Ichai
Université Côte d’Azur, Centre Hospitalier Universitaire de Nice, Département Anesthésie-Réanimation
Laurent Petit
Service de réanimation chirurgicale et traumatologique Pellegrin place Amélie Raba-Léon
Fabienne Tamion
Service de Médecine Intensive Réanimation, CHU Rouen, Université de Normandie, UNIROUEN, INSERM U1096
Abstract Background Current guidelines suggest the introduction of early nutrition support within the first 48 h of admission to the intensive care unit (ICU) for patients who cannot eat. In that context, we aimed to describe nutrition practices in the ICU and study the association between the introduction of early nutrition support ( 3 days were consecutively included and followed for 10 days. Their mortality was assessed at D28. We investigated the association between early nutrition (< 48 h) and mortality at D28 using univariate and multivariate propensity-score-weighted logistic regression analyses. Results During the study period, 1206 patients were included. Early nutrition support was administered to 718 patients (59.5%), with 504 patients receiving enteral nutrition and 214 parenteral nutrition. Early nutrition was more frequently prescribed in the presence of multiple organ failure and less frequently in overweight and obese patients. Early nutrition was significantly associated with D28 mortality in the univariate analysis (crude odds ratio (OR) 1.69, 95% confidence interval (CI) 1.23–2.34) and propensity-weighted multivariate analysis (adjusted OR (aOR) 1.05, 95% CI 1.00–1.10). In subgroup analyses, this association was stronger in patients ≤ 65 years and with SOFA scores ≤ 8. Compared with no early nutrition, a significant association was found of D28 mortality with early enteral (aOR 1.06, 95% CI 1.01–1.11) but not early parenteral nutrition (aOR 1.04, 95% CI 0.98–1.11). Conclusions In this prospective cohort study, early nutrition support in the ICU was significantly associated with increased mortality at D28, particularly in younger patients with less severe disease. Compared to no early nutrition, only early enteral nutrition appeared to be associated with increased mortality. Such findings are in contrast with current guidelines on the provision of early nutrition support in the ICU and may challenge our current practices, particularly concerning patients at low nutrition risk. Trial registration ClinicalTrials.gov Identifier: NCT02599948. Retrospectively registered on November 5th 2015.
