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http://dx.doi.org/10.4163/jnh.2022.55.1.85

Association of the initial level of enteral nutrition with clinical outcomes in severe and multiple trauma patients  

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)
Publication Information
Journal of Nutrition and Health / v.55, no.1, 2022 , pp. 85-100 More about this Journal
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.
Keywords
enteral nutrition; multiple trauma; catabolism; prognosis; mortality;
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