Clinical Nutrition Open Science (Dec 2023)
Early versus late enteral nutrition in US COVID-19 patients: A systematic literature review and meta-analysis
Abstract
Summary: Background & Aims: This systematic review and meta-analysis aims to evaluate the effects on mortality, length of stay in hospital (HLOS) and in intensive care unit (ICU-LOS) of early enteral nutrition (EEN) vs. late enteral nutrition (LEN) on COVID-19 patients in U.S. hospitals. Based on results, we estimated the cost differences between EEN and LEN. Methods: Searches were conducted in databases, including Web of Science, Pubmed and Embase until 28 December 2022. Two reviewers independently screened studies for eligibility, extracted data, and assessed risk of bias. We included randomized controlled trials, prospective and retrospective observational studies which compared EEN and LEN in COVID-19 critically ill adult patient in ICU. Results: We selected 4 studies reporting a timing of EEN varying from 24-72h since patient admission in ICU. For EEN initiated within 72h, the results do not support an effect on mortality with a risk ratio of 0.97 (95% CI, 0.83, 1.14, p = 0.74), while showing an effect on both HLOS and ICU-LOS with a mean difference of respectively -3.54 days (95% CI, -4.85, -2.22, p < 0.00001) and -6.35 days (95% CI, -8.12, -4.57, p =0.00001). The sensitivity analysis confirmed the results also for EEN initiated within 36h. Compared to LEN, we estimated that EEN can lead to substantial cost reduction, $21,525 with EEN <72h. Conclusions: In U.S. COVID-19 patients, compared to LEN, EEN does not affect mortality, it is associated with shorter HLOS, ICU-LOS and relevant cost reduction. The results contradict previous meta-analysis and highlight the role of EEN to reduce hospital related healthcare costs.
