Greater Nutrient Intake Is Associated With Lower Mortality in Western and Eastern Critically Ill Patients With Low BMI: A Multicenter, Multinational Observational Study

摘要

Background: Little is known about the impact of feeding adequacy by NUTrition Risk in the Critically Ill (NUTRIC) groups in critically ill patients with body mass index (BMI) 20. Our purpose was to assess whether adequacy of protein/energy intake impacts mortality in patients with BMI 20 in Western/Eastern intensive care units (ICUs) and high/low NUTRIC groups. Methods: Data from the International Nutrition Survey 2013–2014 were dichotomized into Western/Eastern ICU settings; BMI 20 or ≥20; and high (≥5)/low (5) NUTRIC groups. Association of BMI 20 with 60‐day mortality was compared in unadjusted and adjusted (Western/Eastern, age, medical/surgical admission, high/low NUTRIC group) logistic regression models. The impact of adequacy of protein/energy on 60‐day mortality relationship was tested using general estimating equations in high/low NUTRIC groups, in unadjusted and adjusted models. Results: Western (n = 4274) patients had higher mean BMI (27.9 ± 7.7 versus (vs) 23.4 ± 4.9, P 0.0001) than Eastern (n = 1375), respectively. BMI 20 was associated with greater mortality (adjusted odds ratio [OR] 1.30, 95% confidence interval [CI] 1.07–1.57), with no interaction between BMI group and Western/Eastern ICU site. Among patients with BMI 20 and high NUTRIC score, 10% greater protein and energy adequacy was associated with 5.7% and 5.5% reduction in 60‐day mortality, respectively. Results were not significantly different between Western and Eastern ICUs. Conclusions: The benefit of greater protein/energy intake in high‐NUTRIC patients was observed regardless of geographic origin or low BMI, suggesting a consistent response to nutrition support in this group. Clinical guidelines and research projects focused on improving care in high‐risk critically ill patients can be applied across geographic boundaries.