Abstract
Immune dysfunction is seen both in sepsis patients and in those with malnutrition. This study aimed to determine whether insufficient nutrition and immune dysfunction have a synergistic effect on mortality in critically ill septic patients. We conducted a prospective observational study from adult sepsis patients admitted to intensive care units (ICUs) between August 2013 and June 2016. Baseline characteristics including age, gender, body mass index, NUTRIC, Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores were recorded. Immune dysfunction, defined by human leukocyte antigen DR (HLA-DR) expression, was tested at days 1, 3, and 7 of ICU admission. The study included 151 patients with sepsis who were admitted to the ICU. The 28-day survivors had higher day 7 caloric intakes (89% vs. 73%, p = 0.042) and higher day 1-HLA-DR expression (88.4 vs. 79.1, p = 0.045). The cut-off points of day 7 caloric intake and day 1-HLA-DR determined by operating characteristic curves were 65.1% and 87.2%, respectively. Immune dysfunction was defined as patients with day 1-HLA-DR < 87.2%. Insufficient nutrition had no influence on survival outcomes in patients with immune dysfunction. However, patients with insufficient nutrition had poor prognosis when they were immune competent. Insufficient nutrition and immune dysfunction did not have a synergistic effect on mortality in critically ill septic patients.
Highlights
The association between caloric delivery and clinical outcomes in critically ill patients is a controversial topic in the present day [1]
Of the 2744 patients admitted to the intensive care units (ICUs) from August 2013 to June 2016, 151 sepsis patients were included in the final analyses (Figure 1)
Patients surviving at 28 days after ICU admission had lower Sequential Organ Failure Assessment (SOFA) scores than non-survivors
Summary
The association between caloric delivery and clinical outcomes in critically ill patients is a controversial topic in the present day [1]. It was shown that early parenteral nutrition supplementation in critically ill patients who could not reach a caloric target failed to improve survival outcomes [2,3,4,5]. Several observational studies have demonstrated that insufficient energy delivery is associated with higher mortality rates [6,7]. A prospective pilot study conducted by Petros et al found that hypocaloric feeding was associated with more nosocomial infections in critically ill patients [9]. A recent prospective randomized study conducted by Arabi et al revealed that permissive underfeeding was not associated with higher mortality rates in critically ill patients [10]
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