Lan Tan ^1* Xiaoliang Wang ¹ Xiuling Xie ¹ Xin Xu ²

• ¹ Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Qingdao, Shandong Province, China
• ² Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China

The ideal timing for commencing enteral nutrition (EN) in critically ill stroke patients within the intensive care unit (ICU) remains a subject of debate, with ongoing controversy regarding the influence of early EN initiation. Here, we investigated the association between the timing of EN initiation and 28-days mortality using data from the MIMIC-IV database.Methods: Employing a retrospective cohort design, this study harnessed the MIMIC-IV database to identify stroke patients who received EN during their hospital stay.The main focus of this investigation was to examine 28-days mortality following the hospital admission . The analysis accounted for various demographic, clinical, laboratory, and intervention variables as covariates. COX regression analysis was employed to assess the correlation between the timing of EN initiation and 28-days mortality and RCS (Restricted Cubic Splines) analysis was used to test for nonlinear correlation. Patients were then stratified into 2 cohorts depending on the timing of EN initiation: EN initiation within 2 days (n=564) . EN initiation beyond 2 days(n=433) . Multi-variates COX regression was used to investigate the difference of 28-days mortality between groups.Results: In total, 997 participants were included in the study, with 318 (31.9%) died in 28 days. We observed that the timing of EN initiation was correlated with 28 days mortality but the correlation was not significant after adjusted by covariates (crude HR: 0.94, 95%CI: 0.88~1, p=0.044; adjusted HR:0.96, 95%CI:0.9~1.02, p=0.178).RCS showed that the correlation was not in a nonlinear fashion.Strikingly, compared with the late EN initiation group in the multivariate regression models, a higher mortality rate exhibited in the early EN (OR=1.34, 95% CI: 1.06~1.67, p=0.012). After adjusting for various confounding factors in the multi-variable COX models, we identified that patients in the early EN group had a 28% higher risk of mortality than those in the reference group (OR=1.27, 95% CI:1~1.61, p=0.048). These associations remained consistent across various patient characteristics, as revealed through stratified analyses.The early commencement of EN in ill stroke patients may be linked to a heightened risk of higher 28 days mortality, indicating the need for further investigation and a more nuanced consideration of the optimal timing for commencing EN.