Effect of nutritional support in patients with lower respiratory tract infection: Secondary analysis of a randomized clinical trial

Annic Baumgartner; Flavia Hasenboehler; Jennifer Cantone; Lara Hersberger; Annika Bargetzi; Laura Bargetzi; Nina Kaegi-Braun; Pascal Tribolet; Filomena Gomes; Claus Hoess; Vojtech Pavlicek; Stefan Bilz; Sarah Sigrist; Michael Brändle; Christoph Henzen; Robert Thomann; Jonas Rutishauser; Drahomir Aujesky; Nicolas Rodondi; Jacques Donzé; Zeno Stanga; Beat Mueller; Philipp Schuetz

doi:10.1016/j.clnu.2020.10.009

Effect of nutritional support in patients with lower respiratory tract infection: Secondary analysis of a randomized clinical trial

Clin Nutr. 2021 Apr;40(4):1843-1850. doi: 10.1016/j.clnu.2020.10.009. Epub 2020 Oct 10.

Authors

Annic Baumgartner¹, Flavia Hasenboehler¹, Jennifer Cantone¹, Lara Hersberger¹, Annika Bargetzi¹, Laura Bargetzi¹, Nina Kaegi-Braun², Pascal Tribolet³, Filomena Gomes⁴, Claus Hoess⁵, Vojtech Pavlicek⁵, Stefan Bilz⁶, Sarah Sigrist⁶, Michael Brändle⁶, Christoph Henzen⁷, Robert Thomann⁸, Jonas Rutishauser⁹, Drahomir Aujesky¹⁰, Nicolas Rodondi¹¹, Jacques Donzé¹², Zeno Stanga¹³, Beat Mueller¹, Philipp Schuetz¹⁴

Affiliations

¹ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
² Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
³ Internal Medicine, Spital Lachen, Switzerland; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
⁴ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; The New York Academy of Sciences, New York City, NY, USA.
⁵ Internal Medicine, Kantonsspital Muensterlingen, Switzerland.
⁶ Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland.
⁷ Internal Medicine, Kantonsspital Luzern, Switzerland.
⁸ Department of Internal Medicine, Buergerspital Solothurn, Switzerland.
⁹ Internal Medicine, Kantonsspital Baselland, Switzerland.
¹⁰ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
¹¹ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.
¹² Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland.
¹³ Division of Diabetology, Endocrinology, Nutritional Medicine & Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland.
¹⁴ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland. Electronic address: schuetzph@gmail.com.

Abstract

Background: In polymorbid patients with bronchopulmonary infection, malnutrition is an independent risk factor for mortality. There is a lack of interventional data investigating whether providing nutritional support during the hospital stay in patients at risk for malnutrition presenting with lower respiratory tract infection lowers mortality.

Methods: For this secondary analysis of a randomized clinical trial (EFFORT), we analyzed data of a subgroup of patients with confirmed lower respiratory tract infection from an initial cohort of 2028 patients. Patients at nutritional risk (Nutritional Risk Screening [NRS] score ≥3 points) were randomized to receive protocol-guided individualized nutritional support to reach protein and energy goals (intervention group) or standard hospital food (control group). The primary endpoint of this analysis was all-cause 30-day mortality.

Results: We included 378 of 2028 EFFORT patients (mean age 74.4 years, 24% with COPD) into this analysis. Compared to usual care hospital nutrition, individualized nutritional support to reach caloric and protein goals showed a similar beneficial effect of on the risk of mortality in the subgroup of respiratory tract infection patients as compared to the main EFFORT trial (odds ratio 0.47 [95%CI 0.17 to 1.27, p = 0.136] vs 0.65 [95%CI 0.47 to 0.91, p = 0.011]) with no evidence of a subgroup effect (p for interaction 0.859). Effects were also similar among different subgroups based on etiology and type of respiratory tract infection and for other secondary endpoints.

Conclusion: This subgroup analysis from a large nutrition support trial suggests that patients at nutritional risk as assessed by NRS 2002 presenting with bronchopulmonary infection to the hospital likely have a mortality benefit from individualized inhospital nutritional support. The small sample size and limited statistical power calls for larger nutritional studies focusing on this highly vulnerable patient population.

Clinical trial registration: Registered under ClinicalTrials.gov Identifier no. NCT02517476.

Keywords: COVID19; Malnutrition; Nutritional support; Outcome; Randomized trial; Respiratory infection.

Publication types

Multicenter Study
Randomized Controlled Trial

MeSH terms

Aged
Cohort Studies
Comorbidity
Female
Hospitalization / statistics & numerical data
Humans
Male
Malnutrition / diet therapy*
Malnutrition / epidemiology*
Middle Aged
Nutritional Support / methods*
Respiratory Tract Infections / epidemiology*
Switzerland / epidemiology

Associated data

ClinicalTrials.gov/NCT02517476