AUTHOR=Lv Cheng , Jiang Xingwei , Long Yi , Liu Zirui , Lin Jiajia , Wu Cuili , Ye Xianghong , Ye Ruiling , Liu Yuxiu , Liu Man , Liu Yang , Chen Wensong , Gao Lin , Tong Zhihui , Ke Lu , Jiang Zhengying , Li Weiqin 

TITLE=Association between caloric adequacy and short-term clinical outcomes in critically ill patients using a weight-based equation: Secondary analysis of a cluster-randomized controlled trial

JOURNAL=Frontiers in Nutrition

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2022.902986

DOI=10.3389/fnut.2022.902986

ISSN=2296-861X

ABSTRACT=<sec><title>Background</title><p>There is controversy over the optimal energy delivery in intensive care units (ICUs). In this study, we aimed to evaluate the association between different caloric adequacy assessed by a weight-based equation and short-term clinical outcomes in a cohort of critically ill patients.</p></sec><sec><title>Methods</title><p>This is a secondary analysis of a cluster-randomized controlled trial (<italic>N</italic> = 2,772). The energy requirement was estimated as 25 kcal/kg of body weight. The study subjects were divided into three groups according to their caloric adequacy as calculated by the mean energy delivered from days 3 to 7 of enrollment divided by the estimated energy requirements: (1) received &lt; 70% of energy requirement (hypocaloric), (2) received 70–100% of energy requirement (normocaloric), and (3) received &gt; 100% of energy requirement (hypercaloric). Cox proportional hazards models were used to analyze the association between caloric adequacy and 28-day mortality and time to discharge alive from the ICU.</p></sec><sec><title>Results</title><p>A total of 1,694 patients were included. Compared with normocaloric feeding, hypocaloric feeding significantly increased the risk of 28-day mortality (hazard ratio [<italic>HR</italic>] = 1.590, 95% confidence interval [<italic>CI</italic>]: 1.162–2.176, <italic>p</italic> = 0.004), while hypercaloric feeding did not. After controlling for potential confounders, the association remained valid (adjusted <italic>HR</italic> = 1.596, 95% <italic>CI</italic>: 1.150–2.215, <italic>p</italic> = 0.005). The caloric adequacy was not associated with time to discharge alive from the ICU in the unadjusted and the adjusted models.</p></sec><sec><title>Conclusion</title><p>Energy delivery below 70% of the estimated energy requirement during days 3–7 of critical illness is associated with 28-day mortality.</p></sec><sec><title>Clinical trial registration</title><p>[<ext-link ext-link-type="uri" xlink:href="https://www.isrctn.com/ISRCTN12233792" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.isrctn.com/ISRCTN12233792</ext-link>], identifier [ISRCTN12233792].</p></sec>