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Association between enteral nutrition support and neurological outcome in patients with acute intracranial haemorrhage: A retrospective cohort study.

ABSTRACT: Association between the amount of enteral nutrition (EN) caloric intake and Glasgow coma scale scores at discharge (GCSdis) in intracranial haemorrhage (ICH) was retrospectively investigated in 230 patients in a single center from 2015 and 2017. GCSdis was used as a dichotomous outcome (?8 or >8: 56/230 vs. 174/230) and its association with the amount of EN caloric intake within 48?hours was analysed in four logistic models. Model 1 used EN as a continuous variable and showed association with favourable GCSdis (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01-1.08). Models 2 and 3 categorized EN into two (?25 and >25?kcal/kg/48 hrs) and three caloric intake levels (?10, 10~25, and >25?kcal/kg/48 hrs) respectively, and compared them with the lowest level; highest EN level associated with favourable GCSdis in both model 2 (OR, 2.77; 95%CI, 1.25-6.13) and 3 (OR, 4.68; 95%CI, 1.61-13.61). Model 4 transformed EN into four quartiles (Q1-Q4). Compared to Q1, OR increased stepwise from Q2 (OR 1.80, 95%CI 0.59-5.44) to Q4 (OR 4.71, 95%CI 1.49-14.80). Propensity score matching analysis of 69 matched pairs demonstrated consistent findings. In the early stage of ICH, increased EN was associated with favourable GCSdis.

SUBMITTER: Cheng X

PROVIDER: S-EPMC6848122 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Association between enteral nutrition support and neurological outcome in patients with acute intracranial haemorrhage: A retrospective cohort study.

Cheng Xuping X Ru Weizhe W Du Kailei K Jiang Xuandong X Hu Yongxia Y Zhang Weimin W Xu Yingting Y Shen Yanfei Y

Scientific reports 20191111 1

Association between the amount of enteral nutrition (EN) caloric intake and Glasgow coma scale scores at discharge (GCS<sub>dis</sub>) in intracranial haemorrhage (ICH) was retrospectively investigated in 230 patients in a single center from 2015 and 2017. GCS<sub>dis</sub> was used as a dichotomous outcome (≤8 or >8: 56/230 vs. 174/230) and its association with the amount of EN caloric intake within 48 hours was analysed in four logistic models. Model 1 used EN as a continuous variable and show ...[more]

PMID: 31712731

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Project description:Although enteral nutrition has become one of the standard therapies for patients with acute pancreatitis, the optimal formulae for enteral nutrition have been under debate. Elemental formula is assumed to be suitable in the treatment of patients with acute pancreatitis because it has less stimulating effects for exocrine secretions of the pancreas, simultaneously maintaining gut immunity; however, clinical studies corroborating this assumption have been scarce.We conducted a retrospective cohort study using a Japanese national administrative database between 2010 and 2015. Patients with acute pancreatitis who received enteral feeding within 3 days of admission were identified and divided into two groups according to whether elemental formula was administered. We assessed the impact of elemental formula for the outcomes (primary, in-hospital mortality; secondary, development of sepsis, hospital-free days at 90 days, and total health-care costs) using a multivariate mixed-effect regression analysis and propensity score matching analysis adjusted by a well-validated case-mix adjustment model. Analysis for the subpopulation of patients with severe acute pancreatitis was also performed.Of 243,312 patients with acute pancreatitis, 948 patients were identified and classified into the elemental formula group (N?=?382) and the control group (N?=?566). No significant differences were observed for in-hospital mortality [10.2% in the elemental formula group vs. 11.0% in the control group; adjusted adds ratio (95% confidence interval; CI)?=?0.94 (0.53-1.67)], sepsis development [5.0 vs. 7.1%; adjusted adds ratio (95% CI)?=?0.66 (0.34-1.28)], mean hospital-free days [54 days vs. 51 days; adjusted difference (95% CI)?=?2 days (-?2 to 5)], and mean total health-care costs [$29,360 vs. $34,214; adjusted difference (95% CI)?=?-?$4250 (-?8643 to 141)]. Similar results were also observed in patients with severe acute pancreatitis.The results of our retrospective cohort study using a large-scale national database did not demonstrate the benefit of elemental formula compared to semi-elemental and polymeric formulae in patients with acute pancreatitis. Further assessment of alternative nutritional strategy is expected.

Project description:BackgroundEarly enteral nutrition (EN) in critically ill patients is important and most of them have suffered acute gastrointestinal injury (AGI). In this study, we investigated the influence of short-peptide EN formula and intact-protein EN formula on the prognosis of patients with AGI grades I-II to provide some guidance.MethodsA retrospective cohort study was performed. The primary outcomes were the percentage of EN calories (25 kcal/kg/d) and protein (1.2 g/kg/d) on the 3rd and 7th days of intensive care unit (ICU) admission, EN percent elevation in calories and protein on days 3-7, and the incidence of gastric retention and diarrhea after EN administration. Secondary outcomes included ICU and 28-day mortality, length of ICU stay, total hospitalization cost, and ventilator-free days. Univariate and multivariate Cox regression analysis was used to identify factors associated with gastric retention and diarrhea. And we used Kaplan-Meier survival curves to compare 28-day mortality rates between the two groups.ResultsThere were no statistically significant differences in ICU and 28-day mortality, ICU length of stay, total hospitalization cost, or ventilator-free days in the short-peptide formula group compared with the intact-protein formula group. Kaplan-Meier survival curves of 28-day mortality also showed no statistically significant difference. The EN percent elevation in calories and protein on days 3-7 in the short-peptide formula group was significantly higher than the intact-protein formula group (48% vs. 38%, P=0.03 and 37% vs. 38%, P=0.04, respectively). For gastrointestinal (GI) adverse events, the incidence of gastric retention (15.5% vs. 29.8%, P=0.03) and diarrhea (8.5% vs. 19.8%, P=0.04) were lower in the short-peptide group. In the multivariate-adjusted model, the use of short-peptide formula was the only independent variable of reduction in gastric retention and diarrhea [HR =0.469 (95% CI: 0.239-0.922), P=0.028; and HR =0.394 (95% CI: 0.161-0.965), P=0.041, respectively].ConclusionsShort-peptide formula is more easily tolerated by patients in the acute phase of AGI and can quickly achieve nutritional goals by EN provision, making it the preferred formula for the initiation of EN in the acute phase of AGI.

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Association between enteral nutrition support and neurological outcome in patients with acute intracranial haemorrhage: A retrospective cohort study.

Publications

Association between enteral nutrition support and neurological outcome in patients with acute intracranial haemorrhage: A retrospective cohort study.

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