Association between caloric adequacy and short-term clinical outcomes in critically ill patients using a weight-based equation: Secondary analysis of a cluster-randomized controlled trial

Cheng Lv; Xingwei Jiang; Yi Long; Zirui Liu; Jiajia Lin; Cuili Wu; Xianghong Ye; Ruiling Ye; Yuxiu Liu; Man Liu; Yang Liu; Wensong Chen; Lin Gao; Zhihui Tong; Lu Ke; Zhengying Jiang; Weiqin Li

doi:10.3389/fnut.2022.902986

Association between caloric adequacy and short-term clinical outcomes in critically ill patients using a weight-based equation: Secondary analysis of a cluster-randomized controlled trial

Front Nutr. 2022 Sep 2:9:902986. doi: 10.3389/fnut.2022.902986. eCollection 2022.

Authors

Cheng Lv¹, Xingwei Jiang², Yi Long³, Zirui Liu¹, Jiajia Lin¹, Cuili Wu⁴, Xianghong Ye⁴, Ruiling Ye³, Yuxiu Liu¹, Man Liu¹, Yang Liu¹, Wensong Chen⁵, Lin Gao¹, Zhihui Tong¹, Lu Ke^{1

6}, Zhengying Jiang³, Weiqin Li^{1

6}

Affiliations

¹ Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
² Department of Critical Care Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, China.
³ Department of Critical Care Medicine, Chongqing University Cancer Hospital, Chongqing, China.
⁴ Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
⁵ Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China.
⁶ National Institute of Healthcare Data Science, Nanjing University, Nanjing, China.

Abstract

Background: There is controversy over the optimal energy delivery in intensive care units (ICUs). In this study, we aimed to evaluate the association between different caloric adequacy assessed by a weight-based equation and short-term clinical outcomes in a cohort of critically ill patients.

Methods: This is a secondary analysis of a cluster-randomized controlled trial (N = 2,772). The energy requirement was estimated as 25 kcal/kg of body weight. The study subjects were divided into three groups according to their caloric adequacy as calculated by the mean energy delivered from days 3 to 7 of enrollment divided by the estimated energy requirements: (1) received < 70% of energy requirement (hypocaloric), (2) received 70-100% of energy requirement (normocaloric), and (3) received > 100% of energy requirement (hypercaloric). Cox proportional hazards models were used to analyze the association between caloric adequacy and 28-day mortality and time to discharge alive from the ICU.

Results: A total of 1,694 patients were included. Compared with normocaloric feeding, hypocaloric feeding significantly increased the risk of 28-day mortality (hazard ratio [HR] = 1.590, 95% confidence interval [CI]: 1.162-2.176, p = 0.004), while hypercaloric feeding did not. After controlling for potential confounders, the association remained valid (adjusted HR = 1.596, 95% CI: 1.150-2.215, p = 0.005). The caloric adequacy was not associated with time to discharge alive from the ICU in the unadjusted and the adjusted models.

Conclusion: Energy delivery below 70% of the estimated energy requirement during days 3-7 of critical illness is associated with 28-day mortality.

Clinical trial registration: [https://www.isrctn.com/ISRCTN12233792], identifier [ISRCTN12233792].

Keywords: critical illness; energy intake; hypocaloric feeding; mortality; resting energy expenditure.