Abstract：
OBJECTIVE: The merits of early enteral nutrition (EEN) in patients in the cardiothoracic intensive care unit (CTICU) remain unclear. This retrospective study aimed to address this issue.
METHODS: We analyzed data from the MIMIC IV v2.0 database, including patients with a CTICU stay of ≥4 d. Patients were divided into early and delayed enteral nutrition (EN) groups. Differences in baseline data were corrected using an inverse probability weighting (IPW) approach. Generalized linear models (GLMs) were used to compare trends over time between groups, and survival effects were evaluated with weighted logistic and Cox regression, supplemented by weighted Kaplan-Meier curves. Subgroup analysis facilitated the exploration of potential interactions.
RESULTS: The study included 720 CTICU patients. Following IPW, all baseline variables were balanced. EEN led to shorter hospital and CTICU stays, lower incidence of respiratory and blood infections, and reduced total insulin usage in the first week of CTICU admission, albeit with an increased total gastric residual volume. Mortality risk between the groups did not significantly differ at 28 d or at 1 y. Excessive early energy and protein intake elevated the risk of 28-d mortality, but the relationship may not be linear. Overweight patients or those with fewer comorbidities had a higher mortality risk with EEN.
CONCLUSIONS: EEN may improve short-term outcomes in CTICU patients without a clear survival benefit. Early high caloric and protein intake could lead to adverse outcomes, suggesting a careful evaluation for initiating EN in specific patients.
METHODS: We analyzed data from the MIMIC IV v2.0 database, including patients with a CTICU stay of ≥4 d. Patients were divided into early and delayed enteral nutrition (EN) groups. Differences in baseline data were corrected using an inverse probability weighting (IPW) approach. Generalized linear models (GLMs) were used to compare trends over time between groups, and survival effects were evaluated with weighted logistic and Cox regression, supplemented by weighted Kaplan-Meier curves. Subgroup analysis facilitated the exploration of potential interactions.
RESULTS: The study included 720 CTICU patients. Following IPW, all baseline variables were balanced. EEN led to shorter hospital and CTICU stays, lower incidence of respiratory and blood infections, and reduced total insulin usage in the first week of CTICU admission, albeit with an increased total gastric residual volume. Mortality risk between the groups did not significantly differ at 28 d or at 1 y. Excessive early energy and protein intake elevated the risk of 28-d mortality, but the relationship may not be linear. Overweight patients or those with fewer comorbidities had a higher mortality risk with EEN.
CONCLUSIONS: EEN may improve short-term outcomes in CTICU patients without a clear survival benefit. Early high caloric and protein intake could lead to adverse outcomes, suggesting a careful evaluation for initiating EN in specific patients.
摘要：
目的：心胸重症监护病房（CTICU）患者早期肠内营养（EEN）的优点尚不清楚。这项回顾性研究旨在解决这一问题。
方法：我们分析了来自MIMICIVv2.0数据库的数据，包括CTICU住院时间≥4d的患者。将患者分为早期和延迟肠内营养(EN)组。使用逆概率加权(IPW)方法校正基线数据的差异。广义线性模型(GLM)用于比较组间随时间的趋势，和生存效果用加权logistic和Cox回归进行评估，辅以加权Kaplan-Meier曲线。亚组分析有助于探索潜在的相互作用。
结果：该研究包括720名CTICU患者。在IPW之后,所有基线变量均平衡.EEN导致住院时间缩短，CTCU住院时间缩短，降低呼吸道和血液感染的发生率，在CTCU入院的第一周减少了总胰岛素用量，尽管胃总残留量增加。两组之间的死亡风险在28d或1y时没有显着差异。过度的早期能量和蛋白质摄入会增加28d死亡的风险。但这种关系可能不是线性的。超重患者或合并症较少的患者使用EEN的死亡风险较高。
结论：EEN可以改善CTCU患者的短期预后，但没有明显的生存获益。早期高热量和蛋白质摄入可能导致不良后果，建议仔细评估在特定患者中启动EN。
方法：我们分析了来自MIMICIVv2.0数据库的数据，包括CTICU住院时间≥4d的患者。将患者分为早期和延迟肠内营养(EN)组。使用逆概率加权(IPW)方法校正基线数据的差异。广义线性模型(GLM)用于比较组间随时间的趋势，和生存效果用加权logistic和Cox回归进行评估，辅以加权Kaplan-Meier曲线。亚组分析有助于探索潜在的相互作用。
结果：该研究包括720名CTICU患者。在IPW之后,所有基线变量均平衡.EEN导致住院时间缩短，CTCU住院时间缩短，降低呼吸道和血液感染的发生率，在CTCU入院的第一周减少了总胰岛素用量，尽管胃总残留量增加。两组之间的死亡风险在28d或1y时没有显着差异。过度的早期能量和蛋白质摄入会增加28d死亡的风险。但这种关系可能不是线性的。超重患者或合并症较少的患者使用EEN的死亡风险较高。
结论：EEN可以改善CTCU患者的短期预后，但没有明显的生存获益。早期高热量和蛋白质摄入可能导致不良后果，建议仔细评估在特定患者中启动EN。
