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Abstract：
UNASSIGNED: Early enteral nutrition (EN) is recommended for sepsis management, but its optimal timing and clinical benefits remain uncertain. This study evaluates whether early EN improves outcomes compared to delayed EN in patients with sepsis.
UNASSIGNED: We analyzed data of septic patients from the MIMIC-IV 2.2 database, focusing on those in the Medical Intensive Care Unit (MICU) and Surgical Intensive Care Unit (SICU). Patients who initiated EN within 3 days were classified into the early EN group, while those who started EN between 3 and 7 days were classified into the delayed EN group. Propensity score matching was used to compare outcomes between the groups.
UNASSIGNED: Among 1,111 patients, 786 (70.7%) were in the early EN group and 325 (29.3%) were in the delayed EN group. Before propensity score matching, the early EN group demonstrated lower mortality (crude OR = 0.694; 95% CI: 0.514-0.936; p = 0.018) and shorter ICU stays (8.3 [5.2, 12.3] vs. 10.0 [7.5, 14.2] days; p < 0.001). After matching, no significant difference in mortality was observed. However, the early EN group had shorter ICU stays (8.3 [5.2, 12.4] vs. 10.1 [7.5, 14.2] days; p < 0.001) and a lower incidence of AKI stage 3 (49.3% vs. 55.5%; p = 0.030). Subgroup analysis revealed that early EN significantly reduced the 28-day mortality rate in sepsis patients with lactate levels ≤4 mmol/L, with an adjusted odds ratio (aOR) of 0.579 (95% CI: 0.361, 0.930; p = 0.024).
UNASSIGNED: Early enteral nutrition may not significantly reduce overall mortality in sepsis patients but may shorten ICU stays and decrease the incidence of AKI stage 3. Further research is needed to identify specific patient characteristics that benefit most from early EN.
UNASSIGNED: We analyzed data of septic patients from the MIMIC-IV 2.2 database, focusing on those in the Medical Intensive Care Unit (MICU) and Surgical Intensive Care Unit (SICU). Patients who initiated EN within 3 days were classified into the early EN group, while those who started EN between 3 and 7 days were classified into the delayed EN group. Propensity score matching was used to compare outcomes between the groups.
UNASSIGNED: Among 1,111 patients, 786 (70.7%) were in the early EN group and 325 (29.3%) were in the delayed EN group. Before propensity score matching, the early EN group demonstrated lower mortality (crude OR = 0.694; 95% CI: 0.514-0.936; p = 0.018) and shorter ICU stays (8.3 [5.2, 12.3] vs. 10.0 [7.5, 14.2] days; p < 0.001). After matching, no significant difference in mortality was observed. However, the early EN group had shorter ICU stays (8.3 [5.2, 12.4] vs. 10.1 [7.5, 14.2] days; p < 0.001) and a lower incidence of AKI stage 3 (49.3% vs. 55.5%; p = 0.030). Subgroup analysis revealed that early EN significantly reduced the 28-day mortality rate in sepsis patients with lactate levels ≤4 mmol/L, with an adjusted odds ratio (aOR) of 0.579 (95% CI: 0.361, 0.930; p = 0.024).
UNASSIGNED: Early enteral nutrition may not significantly reduce overall mortality in sepsis patients but may shorten ICU stays and decrease the incidence of AKI stage 3. Further research is needed to identify specific patient characteristics that benefit most from early EN.
摘要：
■建议早期肠内营养（EN）用于败血症管理，但其最佳时机和临床获益仍不确定.这项研究评估了与脓毒症患者的延迟EN相比，早期EN是否可以改善预后。
■我们分析了MIMIC-IV2.2数据库中的脓毒症患者数据，重点关注医疗重症监护病房（MICU）和外科重症监护病房（SICU）。在3天内开始EN的患者被分为早期EN组。而那些在3至7天之间开始EN的人被归类为延迟EN组。倾向评分匹配用于比较组间的结果。
■在1,111名患者中，早期EN组786例（70.7%），延迟EN组325例（29.3%）。在倾向得分匹配之前，早期EN组的死亡率较低（粗OR=0.694；95％CI：0.514-0.936；p=0.018）和ICU住院时间较短（8.3[5.2,12.3]vs.10.0[7.5,14.2]天；p<0.001）。匹配后,死亡率无显著差异.然而,早期EN组的ICU住院时间较短（8.3[5.2，12.4]vs.10.1[7.5，14.2]天；p<0.001），AKI3期的发生率较低（49.3％vs.55.5%；p=0.030）。亚组分析显示，早期EN显著降低乳酸水平≤4mmol/L的脓毒症患者的28天死亡率，调整后的比值比（aOR）为0.579（95%CI：0.361，0.930；p=0.024）。
■早期肠内营养可能不会显著降低脓毒症患者的总死亡率，但可能会缩短ICU住院时间并降低AKI3期的发生率。需要进一步的研究来确定从早期EN中受益最多的特定患者特征。
■我们分析了MIMIC-IV2.2数据库中的脓毒症患者数据，重点关注医疗重症监护病房（MICU）和外科重症监护病房（SICU）。在3天内开始EN的患者被分为早期EN组。而那些在3至7天之间开始EN的人被归类为延迟EN组。倾向评分匹配用于比较组间的结果。
■在1,111名患者中，早期EN组786例（70.7%），延迟EN组325例（29.3%）。在倾向得分匹配之前，早期EN组的死亡率较低（粗OR=0.694；95％CI：0.514-0.936；p=0.018）和ICU住院时间较短（8.3[5.2,12.3]vs.10.0[7.5,14.2]天；p<0.001）。匹配后,死亡率无显著差异.然而,早期EN组的ICU住院时间较短（8.3[5.2，12.4]vs.10.1[7.5，14.2]天；p<0.001），AKI3期的发生率较低（49.3％vs.55.5%；p=0.030）。亚组分析显示，早期EN显著降低乳酸水平≤4mmol/L的脓毒症患者的28天死亡率，调整后的比值比（aOR）为0.579（95%CI：0.361，0.930；p=0.024）。
■早期肠内营养可能不会显著降低脓毒症患者的总死亡率，但可能会缩短ICU住院时间并降低AKI3期的发生率。需要进一步的研究来确定从早期EN中受益最多的特定患者特征。
