Associations between enteral nutrition and outcomes in the <scp>SUP</scp>‐<scp>ICU</scp> trial: Results of exploratory post hoc analyses-Reference-Cited by-同舟云学术

Associations between enteral nutrition and outcomes in the SUP‐ICU trial: Results of exploratory post hoc analyses

Published:2024-06-12 Issue: Volume: Page:
ISSN:0001-5172
Container-title:Acta Anaesthesiologica Scandinavica
language:en
Short-container-title:Acta Anaesthesiol Scand

Author:

Borthwick Mark¹^ORCID,Granholm Anders²³^ORCID,Marker Søren²³^ORCID,Krag Mette³⁴,Lange Theis⁵,Wise Matt P.⁶^ORCID,Bendel Stepani⁷,Keus Frederik⁸^ORCID,Guttormsen Anne Berit⁹¹⁰,Schefold Joerg C.¹¹^ORCID,Wetterslev Jørn³¹²,Perner Anders²³¹³^ORCID,Møller Morten Hylander²³^ORCID

Affiliation:

1. Departments of Pharmacy and Critical Care Oxford University Hospitals NHS Foundation Trust Oxford UK

2. Department of Intensive Care Copenhagen University Hospital—Rigshospitalet Copenhagen Denmark

3. Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark

4. Department of Intensive Care Holbæk Hospital Holbæk Denmark

5. Section of Biostatistics University of Copenhagen Copenhagen Denmark

6. Department of Adult Critical Care University Hospital of Wales Cardiff UK

7. Department of Intensive Care Medicine Kuopio University Hospital Kuopio Finland

8. Department of Critical Care, University Medical Center Groningen University of Groningen Groningen The Netherlands

9. Department of Anaesthesia and Intensive Care, Haukeland University Hospital University of Bergen Bergen Norway

10. Department of Clinical Medicine University of Bergen Bergen Norway

11. Department of Intensive Care Medicine, Inselspital University of Bern Bern Switzerland

12. Private office, Tuborg Sundpark Copenhagen Denmark

13. Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Abstract

AbstractBackgroundEnteral nutrition may affect risks of gastrointestinal bleeding, pneumonia and mortality in critically ill patients and may also modify the effects of pharmacological stress ulcer prophylaxis. We undertook post hoc analyses of the stress ulcer prophylaxis in the intensive care unit trial to assess for any associations and interactions between enteral nutrition and pantoprazole.MethodsExtended Cox models with time‐varying co‐variates and competing events were used to assess potential associations, adjusted for baseline severity of illness. Potential interactions between daily enteral nutrition and allocation to pantoprazole on outcomes were similarly assessed.ResultsEnteral nutrition was associated with lower risk of clinically important gastrointestinal bleeding (cause‐specific hazard ratio [HR]: 0.29, 95% confidence interval: [CI] 0.19–0.44, p < .001), higher risk of pneumonia (HR: 1.44, 95% CI: 1.14–1.82, p = .003), and lower risk of all‐cause mortality (HR: 0.22, 95% CI: 0.18–0.27, p < .001). Enteral nutrition with allocation to pantoprazole was associated with a lower risk of mortality (HR: 0.27, 95% CI: 0.21–0.35, p < .001), similar to enteral nutrition with allocation to placebo (HR: 0.17, 95% CI: 0.13–0.23, p < .001). Allocation to pantoprazole with no enteral nutrition had little effect on mortality (HR: 0.83, 95% CI: 0.63–1.09, p = .179), whilst allocation to pantoprazole and receipt of enteral nutrition was mostly compatible with increased all‐cause mortality (HR: 1.27, 95% CI: 0.99–1.64, p = .061). The test of interaction between enteral nutrition and pantoprazole treatment allocation for all‐cause mortality was statistically significant (p = .024).ConclusionsEnteral nutrition was associated with an increased risk of pneumonia and a reduced risk of gastrointestinal bleeding. The interaction between pantoprazole and enteral nutrition suggesting an increased risk of mortality requires further study.

Funder

Innovationsfonden

Rigshospitalet

Region Hovedstaden

Publisher

Wiley

Link

https://onlinelibrary.wiley.com/doi/pdf/10.1111/aas.14471

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