Early versus delayed enteral nutrition in ICU patients with sepsis: a propensity score- matched analysis based on the MIMIC-IV database

Abstract

Abstract Background Nutrition therapy is an integral part of the management of patients with sepsis. Recently, published guidelines recommend early initiation of enteral nutrition in adults with sepsis who can be fed enterally. However, early enteral nutrition's optimal timing and clinical benefits are still unclear. This study aimed to evaluate whether early enteral nutrition improves clinical outcomes in patients with sepsis compared with delayed enteral nutrition. Methods We utilized data from septic patients in the Medical Information Mart for Intensive Care (MIMIC)-IV 2.2 database and categorized those who began enteral nutrition (EN) within 3 days of admission to the ICU as the early enteral nutrition (EEN) group and those who began EN between 3–7 days after ICU admission as the delayed enteral nutrition (DEN) group. The main outcome was 28-day mortality. We conducted propensity score-matched analyses to compare outcomes between the two groups. Subgroup analyses were performed to determine whether different groups of septic patients had better outcomes with early enteral nutrition. Results We identified 2267 eligible patients, including 1594 patients (70.3%) in the early EN group and 673 (29.7%) in the delayed EN group. Before propensity matching, we found that the EEN group had lower 28-day mortality than the DEN group (crude OR = 0.789 (0.637–0.977); p = 0.030), fewer ICU stays (8.36 (5.00-12.99) vs. 10.42 (7.83-15.00); p < 0.001), and a lower incidence of stage 3 AKI (35.1% vs. 50.2%; p < 0.001). After propensity score matching, there was no significant difference in 28-day mortality (OR = 0.808 (0.622–1.050); p = 0.111). However, the duration of ICU stay in the early EN group was still lower than that in the delayed EN group (8.83 (5.03-13.00) vs. 10.41 (7.83–14.89); p < 0.001), and the incidence of stage 3 AKI was lower (39.6% vs. 49.3%; p < 0.001). Subgroup analysis showed that the MICU group (adjusted OR = 0,631 (0,428-0,930); p = 0.020) and the male group (adjusted OR = 0,668 (0,455-0,981), p = 0,040) were associated with reduced 28-day mortality with early enteral nutrition. Conclusions For septic patients, early enteral nutrition may not reduce mortality. However, early enteral nutrition reduced the ICU length of stay and incidence of stage 3 AKI in sepsis patients. We also found that patients with sepsis in the MICU and males may benefit more from early enteral nutrition through subgroup analysis. Which patients with sepsis may benefit from early enteral nutrition needs to be further investigated.