Associations between parenteral energy/amino acids and clinical outcomes in long-term fasting ICU patients: A retrospective cohort study using a medical claims database

Abstract BackgroundThe aim of this study was to clarify the associations between energy/amino acid doses and clinical outcomes for intensive care unit (ICU) patients receiving parenteral nutrition.MethodsICU patients aged ≥ 18, receiving mechanical ventilation, and fasting for > 7 days were identified in a medical claims database between January 2010 and June 2020 and were compared in 3 different ways by: (1) mean daily energy dose (Low-calorie < 10 kcal/kg/day; Middle-calorie ≥ 10, < 20 kcal/kg/day; High-calorie, ≥ 20 kcal/kg/day); (2) mean daily amino acid dose (Low-amino acid < 0.3 g/kg/day; Middle-amino acid ≥ 0.3, < 0.6 g/kg/day; High-amino acid ≥ 0.6 g/kg/day); and (3) mean daily energy/amino acid dose combinations. The primary endpoint was in-hospital mortality, and secondary endpoints were hospital readmission and length of stay. Multivariate logistic or multiple regression analyses were performed to calculate adjusted odds ratios (AOR) or adjusted regression coefficients and 95% confidence intervals (CI). ResultsA total of 20,773 patients were included. With a reference of Low-calorie, AOR (95% CI) of in-hospital mortality was lower for Middle-calorie (0.85 [0.78-0.92]). With a reference of Low-amino acid, it was lower for High-amino acid (0.69 [0.63-0.76]). With a reference of Middle-calorie/High-amino acid, it was highest in High-calorie/Low-amino acid (2.25 [1.76-2.87]) and High-calorie/Middle-amino acid (1.68 [1.36-2.08]), and did not differ in Low-calorie/High-amino acid (1.10 [0.78-1.56]) and High-calorie/High-amino acid (1.16 [0.99-1.35]).ConclusionsIn ICU patients receiving only parenteral nutrition, in-hospital mortality was lower when at least 0.6 g/kg/day-amino acid is prescribed regardless of the amount of prescribed calories. Attention on amino acid doses is needed in such patients.Trial registrationThe study was conducted after being registered in the clinical study registration system in the University hospital Medical Information Network (UMIN) clinical trial registry (Japan) (UMIN000042607). Retrospectively registered December 1, 2020. Available at: https://upload.umin.ac.jp/cgi-open bin/ctr_e/ctr_view.cgi?recptno=R000048553