Early Enteral Nutrition and Sepsis-Associated Acute Kidney Injury: A Propensity Score Matched Cohort Study Based on the MIMIC-III Database

Jin-Bao Zhang; Jun Wang; Li Jiang; Sheng Ding; Si-Yi He; Shun-Bi Liu; Zhong-Jie Lu; Yuan-Zhang Liu; Li-Wen Hou; Bin-Su Wang

doi:10.3349/ymj.2022.0276

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자료유형: 학술저널

저자정보: Jin-Bao Zhang (People’s Liberation Army The General Hospital of Western Theater Command Chengdu Sichuan China) Jun Wang (People’s Liberation Army The General Hospital of Western Theater Command Chengdu Sichuan China) Li Jiang (People’s Liberation Army The General Hospital of Western Theater Command Chengdu Sichuan China) Sheng Ding (People’s Liberation Army The General Hospital of Western Theater Command Chengdu Sichuan China) Si-Yi He (People’s Liberation Army The General Hospital of Western Theater Command Chengdu Sichuan China) Shun-Bi Liu (People’s Liberation Army The General Hospital of Western Theater Command Chengdu Sichuan China) Zhong-Jie Lu (People’s Liberation Army The General Hospital of Western Theater Command Chengdu Sichuan China) Yuan-Zhang Liu (People’s Liberation Army The General Hospital of Western Theater Command Chengdu Sichuan China) Li-Wen Hou (People’s Liberation Army The General Hospital of Western Theater Command Chengdu Sichuan China) Bin-Su Wang (People’s Liberation Army The General Hospital of Western Theater Command Chengdu Sichuan China)

저널정보: 연세대학교 의과대학 Yonsei Medical Journal Yonsei Medical Journal 제64권 제4호

발행연도: 2023.4

수록면: 259 - 268 (10page)

DOI: 10.3349/ymj.2022.0276

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Purpose: We aimed to analyze the optimal timing of enteral nutrition (EN) in the treatment of sepsis and its effect on sepsis-asso ciated acute kidney injury (SA-AKI.)Materials and Methods: The MIMIC-III database was employed to identify patients with sepsis who had received EN. With AKI as the primary outcome variable, receiver operating characteristic (ROC) curves were utilized to calculate the optimal cut-off time of early EN (EEN). Propensity score matching (PSM) was employed to control confounding effects. Logistic regressions and propen sity score-based inverse probability of treatment weighting were utilized to assess the robustness of our findings. Comparisons within the EEN group were performed. Results: 2364 patients were included in our study. With 53 hours after intensive care units (ICU) admission as the cut-off time of EEN according to the ROC curve, 1212 patients were assigned to the EEN group and the other 1152 to the delayed EN group. The risk of SA-AKI was reduced in the EEN group (odds ratio 0.319, 95% confidence interval 0.245–0.413, p<0.001). The EEN patients re ceived fewer volumes (mL) of intravenous fluid (IVF) during their ICU stay (3750 mL vs. 5513.23 mL, p<0.001). The mediating ef fect of IVF was significant (p<0.001 for the average causal mediation effect). No significant differences were found within the EEN group (0–48 hours vs. 48–53 hours), except that patients initiating EN within 48 hours spent fewer days in ICU and hospital. Conclusion: EEN is associated with decreased risk of SA-AKI, and this beneficial effect may be proportionally mediated by IVF volume.

#Enteral nutrition #sepsis #acute kidney injury #critical care

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