Journal of Nutrition and Health

The Korean Nutrition Society (한국영양학회)
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Association of the initial level of enteral nutrition with clinical outcomes in severe and multiple trauma patients

초기 경장영양 공급 수준과 다발성 외상 중환자의 임상 경과와의 상관성 연구

  • Yang, Suyoung (Department of Clinical Nutrition, The Graduate School of Converging Clinical & Public Health, Ewha Womans University) ;
  • Jung, Seungyoun (Department of Nutritional Science and Food Management, Ewha Womans University) ;
  • Lee, Ji-hyun (Food Services & Clinical Nutrition Team, Ajou University Hospital) ;
  • Kwon, Junsik (Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine) ;
  • Kim, Yuri (Department of Clinical Nutrition, The Graduate School of Converging Clinical & Public Health, Ewha Womans University)
  • 양수영 (이화여자대학교 임상보건융합대학원) ;
  • 정승연 (이화여자대학교 식품영양학과) ;
  • 이지현 (아주대학교병원 영양팀) ;
  • 권준식 (아주대학교병원 외과학교실 외상외과) ;
  • 김유리 (이화여자대학교 임상보건융합대학원)
  • Received : 2021.11.26
  • Accepted : 2022.01.11
  • Published : 2022.02.28
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Abstract

Purpose: This study is aimed to examine the association between initial enteral nutrition (EN) and the clinical prognosis among patients with severe and multiple traumatic injuries, and to investigate whether this association is modified by the patients' catabolic status. Methods: This was a retrospective study of 302 adult patients with severe and multiple traumatic injuries admitted between January 2017 and September 2020 at Ajou University hospital in Suwon, Korea. The initial nutritional support by EN and parenteral nutrition were monitored up to day 7 after admission. Patients were classified into "No", "Low", and "High" EN groups according to the level of initial EN. Multivariable-adjusted logistic regression and linear regression models were used to estimate the association of the initial EN levels at hospital admission with the risk of mortality, morbidities, and levels of nutrition-associated biochemical markers. Results: High EN support was associated with reduced mortality (odds ratio, 0.07; 95% confidence interval [CI], 0.02, 0.32) and lower levels of C-reactive protein (β, -0.22; 95% CI, -8.66, 1.48), but longer stay in the intensive care unit (β, 0.19; 95% CI, 1.82, 11.32). In analyses stratified by catabolic status, there were fewer incidences of hospital-acquired infections with increasing EN levels in the moderate or higher nitrogen balance group than in the mild nitrogen balance group. Conclusion: Our observation of the inverse association between levels of initial EN administration with mortality risk and inflammatory markers may indicate the possible benefits of active EN administration to the recovery process of severe and multiple trauma patients. Further studies are warranted on whether the catabolic status modifies the association between the initial EN and prognosis.

본 연구에서는 다발성 외상 중환자에게 있어 급성 단계에서의 이화학적 상태 및 경장영양 공급 수준이 임상적 예후에 미치는 영향을 알아보고자 하였다. 먼저 조사 대상자 302명의 특성을 분석한 결과, 남성의 비율이 높으며 다른 중환자실에 비해 연령이 낮게 나타났으며 과체중의 체격을 가지고 있었다. 입원 후 7일간의 경장영양 공급 수준에 따라 일반적 결과와 합병증 발생률, 영양 관련 생화학적 지표를 비교한 결과, 초기 경장영양이 가장 적극적으로 공급되었던 High EN 그룹에서 사망률, CRP에서 유의적으로 감소하였다. 질소 평형을 기준으로 이화상태가 양호한 그룹에서는 경장영양 공급 기간이 길수록 HAIs 발생률이 높았으나, 이화상태가 불량한 그룹에서는 적극적인 경장영양 공급에도 여러 합병증 발생이 증가하지 않았다. 생화학적 검사 결과에서는 그룹 간 유의적인 차이가 없었으며, 경장영양 공급 수준에 따른 사망률 감소 추세는 두 그룹 모두에서 유지되었다. 결론적으로, 본 연구에서는 사망률 감소, 염증 수치의 감소 등에서 초기 경장영양 공급 일수가 증가할수록 긍정적인 효과를 확인하였다. 단, 후향적 관찰연구라는 제한점을 미루어 보아 향후 연속적으로 이화상태를 모니터링 및 평가하며 기본 특성의 차이가 없는 그룹 간에서 경장영양 공급 수준을 차별화한 전향적 코호트 연구가 필요하겠다.

Keywords

References

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