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Prognostic Value of Prolonged Feeding Intolerance in Predicting All‐Cause Mortality in Critically Ill Patients: A Multicenter, Prospective, Observational Study
Author(s) -
Hu Bangchuan,
Sun Renhua,
Wu Aiping,
Ni Yin,
Liu Jingquan,
Guo Feng,
Ying Lijun,
Ge Guoping,
Ding Aijun,
Shi Yunchao,
Liu Changwen,
Xu Lei,
Jiang Ronglin,
Lu Jun,
Lin Ronghai,
Zhu Yannan,
Wu Weidong,
Xie Bo
Publication year - 2020
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1693
Subject(s) - medicine , mechanical ventilation , intensive care , observational study , weaning , prospective cohort study , odds ratio , mortality rate , cohort study , pediatrics , intensive care medicine
Background The 2012 European Society of Intensive Care Medicine (ESICM) guidelines provided a clear definition of feeding intolerance (FI). The study aimed to investigate the association between FI based on the current ESICM definition and clinical outcome and to further explore the effect of the duration of FI on mortality. Methods Adult patients from 14 general intensive care units (ICUs) with an expected ICU stay ≥24 hours were prospectively studied. Based on FI duration in the first week of admission to the ICU, FI was categorized as 7‐day persistent feeding tolerance (FT), delayed FT, delayed FI, and 7‐day persistent FI. The primary outcomes were 28‐day and 60‐day all‐cause mortality. Results Of 499 patients, the prevalence of 3‐day and 7‐day persistent FI was 39.2% (n = 196) and 25.4% (n = 106), respectively. The patients with 3‐day FT had lower risk of 28‐day and 60‐day mortality rates and higher prevalence in ventilator weaning and vasoactive medication on the seventh day of ICU admission than those with 3‐day FI. Three‐day FI remained an independent predictor for 60‐day mortality. In a subgroup analysis including 418 patients with 7‐day survival, compared with those with 7‐day persistent FT, the odds ratios of 60‐day mortality were 1.67, 1.97, and 2.62 in the patients with delayed FT, delayed FI, and 7‐day persistent FI, respectively. Conclusion FI was associated with increased mortality and longer duration of mechanical ventilation and vasoactive support. Prolonged or relapsing FI represented an incremental risk of adverse outcomes in critically ill patients.