Abstract
The clinical conditions of critically ill patients are highly heterogeneous; therefore, nutrient requirements should be personalized based on the patient’s nutritional status. However, nutritional status is not always considered when evaluating a patient’s nutritional therapy in the medical intensive care unit (ICU). We conducted a retrospective cross-sectional study to assess the effect of ICU patients’ nutrition risk status on the association between energy intake and clinical outcomes (i.e., hospital, 14-day and 28-day mortality). The nutrition risk of critically ill patients was classified as either high- or low-nutrition risk using the modified Nutrition Risk in the Critically Ill score. There were 559 (75.3%) patients in the high nutrition risk group, while 183 patients were in the low nutrition risk group. Higher mean energy intake was associated with lower hospital, 14-day and 28-day mortality rates in patients with high nutrition risk; while there were no significant associations between mean energy intake and clinical outcomes in patients with low nutrition risk. Further examination of the association between amount of energy intake and clinical outcomes showed that patients with high nutrition risk who consumed at least 800 kcal/day had significantly lower hospital, 14-day and 28-day mortality rates. Although patients with low nutrition risk did not benefit from high energy intake, patients with high nutrition risk are suggested to consume at least 800 kcal/day in order to reduce their mortality rate in the medical ICU.
Highlights
The clinical conditions of critically ill patients are highly heterogeneous
We further examined the minimal amount of energy intake required to reduce the mortality rate in our critically ill patients by calculating odds ratio for each different value of energy intake
Regardless of the distribution of high and low nutrition risk among studies, our findings were similar to those of other studies [9,11,13], in that high energy intake was associated with low hospital, 14-day and 28-day mortality rates in the critically ill patients with high nutrition risk
Summary
The clinical conditions of critically ill patients are highly heterogeneous. Previous studies showed no outcome differences among trophic feeding, permissive under feeding and full caloric feeding among critically ill patients [3,4]. Nutrients 2018, 10, 1731 with a large sample size conducted by Arabi et al [5] found no significant difference in 90-day mortality of critically ill patients between permissive underfeeding (n = 448) and standard enteral feeding (n = 446) at 7 centers. The lack of nutrition risk stratification might explain why there were no differences in clinical outcome among studies using different feeding strategies. According to the ASPEN/SCCM guidelines, nutritional therapy for critically ill patients should take nutritional status into account which can be assessed using the Nutritional Risk Screening 2002 or the Nutrition
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