Factors impact on insufficient nutrition and effects of timely adequate nutrition support on patient outcomes in adult intensive care unit patients

Objective: Most of the studies comparing effects of enteral and parenteral nutrition on morbidity and mortality have been performed on surgery patient groups or in mixed intensive care unit (ICU) patients. Numbers of studies performed in medical ICUs are limited and they all have small number of patients. In the present study we aimed to analyze association of adequacy of nutrition support with infectious complications, length of stay in ICU and hospital, and mortality in medical ICU patients and causes of insufficient nutrition in patients who are not met target daily caloric intake. Methods: Data of patients who were hospitalized in medical ICU between January 2012 and December 2013 were reviewed retrospectively. Patients older than 18 years of age and who had been dependent to mechanical ventilation for at least 3 days were included. 220 patients were determined after retrospective review of patient files with laboratory and imaging results. Results: 133 of 220 patients were male and 87 of them were female. 151 patients reached the target caloric intake while 69 patients did not. When assessed based on severity of disease, in the adequate caloric intake group APACHE-II score was 23,6±7,7 while it was 25,6±8,7 in the insufficient caloric intake group. Difference between APACHE-II scores was not statistically significant (p>0,05). Mean target calorie was 1579 kcal/d in the adequate caloric intake group, and 1739 kcal/d in insufficient caloric intake group (p<0,001). According to logistic regression analysis which included age, gender, APACHE II score and other comorbidities parenteral nutrition and lymphoma were found to be major independent risk factors for insufficient calorie intake. The number of comorbidity in the adequate caloric intake group and in insufficient caloric intake group was similar (1,91±1,07/1,87±1,00; p>0,05). The most common cause for cessation of nutrition was detection of a residual. Nosocomial infection frequency in adequate and insufficient caloric intake groups were similar, respectively. Enteral nutrition was the most effective feeding way in adequate caloric intake group (p<0,002). Parenteral nutrition and immunosupressive treatment were major independent risks for mortality based on logistic regression analysis which included age, gender, APACHE II score and other comorbidities. Mortality of patients in adequate and insufficient caloric intake groups was 53% and 76%, respectively (p<0,002). Conclusion: Enteral nutrition in critical care patients is safe and effective. Patients who were feeded enterally were more associated with reaching the target caloric intake. Quantity of comorbodities and APACHE II score were not associated with reaching the target calorie intake. Lymphoma and parenteral nutritıon were independent risk factors of mortality. The major independent risks of mortality were parenteral nutrition and immunosupressive treatment in the logistic regression analysis. Mortality of patients in groups of adequate and insufficient calorie intake was 53% and 76%, respectively (p<0,002). Keywords: Nutrition, calorie, morbidity and mortality,