Medical nutrition therapy and clinical outcomes in critically ill adults: A European multinational, prospective observational cohort study (EuroPN)

Background: Medical nutrition therapy may be associated with clinical outcomes in critical ill patients with prolonged ICU stay. We wanted to assess nutrition practices in European intensive care units (ICU) and their relevance for clinical outcomes. Methods: : Prospective multinational observational study including patients in ICU ≥5 days with a follow-up until day 90. Macronutrient intake during the first 15 days after ICU admission was compared with targets recommended by ESPEN guidelines. We determined independent predictors of macronutrient intake and modelled associations between three categories of daily calorie and protein intake (low: <10 kcal/kg, 20 kcal/kg; >1.2 g/kg) and the time-varying hazard rates of 90-day mortality or successful weaning from invasive mechanical ventilation (IMV). Hazard ratios were calculated from piece-wise exponential additive mixed models to compare several different hypothetical medical nutrition therapies. Results: : 1172 patients with median [Q1;Q3] APACHE II score of 18.5 [13.0;26.0] were included, and 23.5% died until day 90. Median length of ICU stay was 10.0 [7.0;16.0] days, 73.9% of patients could be weaned from invasive mechanical ventilation. Patients reached on average 83.1% [59.2;106.6] and 64.5% [41.4;90.9] of ESPEN calorie and protein recommended targets, respectively. Whereas specific reasons for ICU admission (especially respiratory diseases requiring IMV) were associated with higher intakes, a lack of nutrition on the preceding day was associated with lower intakes. Daily moderate calorie and moderate protein intake were associated with higher probability of successful weaning, and, for calories, lower hazards of death compared to a lower intake. There was no evidence that a high calorie or protein intake was associated with further outcome improvements. Conclusions: : Calorie intake was mainly provided according to the recommended targets by the ESPEN guideline, but protein intake was lower. Early moderate daily calorie and protein intakes were associated with improved clinical outcomes. Trial Registration: ClinicalTrials.gov NCT04143503, registered on October 25, 2019