Effects of early enteral nutrition on persistent inflammation, immunosuppression, and catabolism syndrome in critically ill patients

Abstract

Abstract Purpose: Early enteral nutrition (EEN) is controversial whether to reduce infectious complications via preserving intestinal immunity in critically ill patients. Herein, we investigated the association between EEN and an immunocompromised state after critical illness as persistent inflammation, immunosuppression, and catabolism syndrome (PICS). Methods: This propensity score matching analysis utilized the administrative claims database of inpatients. Patients admitted to the intensive care unit (ICU) for more than 3 consecutive days were included. A composite of mortality and PICS: at least two of the following conditions of CRP >2.0 mg/dL, albumin <3.0 g/dL and a lymphocyte count <800/μL on day 14 after admission, was compared as the primary outcome between the EEN group, which received enteral nutrition (EN) on the first 3 days (day 0, 1, or 2), and the late EN (LEN) group, which received EN on days 3 through 7. Results: 7,530 matched pairs were generated. The primary outcome was significantly lower in the EEN group (risk difference -3.0%, 95% confidence interval (CI) -4.5 to -1.4%), whereas mortality did not significantly differ. The 28-day composite outcome was also similar. There was no significant difference in in-hospital mortality between the EEN and LEN groups; however, the Barthel index at discharge was higher in the EEN group (the medians, 50 vs 45, P=0.001). Laboratory data showed lower Albumin and CRP on day 14 in the EEN group. Conclusions: EEN was associated with a lower incidence of PICS on days 14 and 28 in the critically ill patients.