Background
Methods
Study design
Study population
Variables
Patients with missing outcomes
Statistical analysis
Results
Characteristics of enrolled patients
Variable | Total (n = 1953) | Survivors (n = 1483) | Nonsurvivors (n = 312) | Lost to follow up (n = 158) | p value |
---|---|---|---|---|---|
Study day with reference to ICU entry | 7 (2, 19) | 7 (2, 19) | 6 (2, 15.5) | 7 (3, 20) | 0.131 |
Age | 67 (51, 80) | 66 (51, 80) | 70 (57.75, 81) | 69.5 (51, 81) | 0.008 |
Sex (male, %) | 1315 (0.67) | 1011 (0.68) | 197 (0.63) | 107 (0.68) | 0.216 |
Source of admission | |||||
Emergency room | 664 (0.35) | 509 (0.35) | 95 (0.32) | 60 (0.39) | 0.008 |
Surgery | 545 (0.29) | 430 (0.3) | 73 (0.24) | 42 (0.27) | 0.008 |
Internal medicine | 362 (0.19) | 255 (0.18) | 81 (0.27) | 26 (0.17) | 0.008 |
Other ward | 126 (0.07) | 96 (0.07) | 16 (0.05) | 14 (0.09) | 0.008 |
Other hospital | 202 (0.11) | 155 (0.11) | 36 (0.12) | 11 (0.07) | 0.008 |
Past weight | 65 (60, 75) | 65 (59.45, 75) | 65 (58, 74) | 67 (60, 75) | 0.443 |
Temporal weight | 65 (55, 70) | 65 (55, 70) | 63 (54.2, 70) | 65 (60, 70) | 0.263 |
Height | 170 (160, 175) | 170 (160, 175) | 167 (160, 173) | 170 (160, 175) | 0.034 |
CRP (mmol/l) | 44.6 (16.8, 95.95) | 40.05 (15.5, 87) | 74.1 (29.85, 139.75) | 43.75 (14.3, 98.53) | 0 |
Lymphocyte (%) | 10.7 (6.3, 17.6) | 11.1 (6.8, 18.4) | 8 (5.07, 13.85) | 10.1 (6.3, 16.7) | 0 |
Albumin (mg/dl) | 31.7 (27.8, 35.3) | 32 (28.1, 35.6) | 30 (26.2, 34.2) | 32 (28.55, 35.35) | 0 |
Maximum BG (mmol/l) | 10.1 (8, 13.1) | 10 (7.9, 12.9) | 11.1 (8.75, 14.85) | 11.3 (8.3, 13.8) | 0 |
Minimum BG (mmol/l) | 6.4 (5.4, 7.8) | 6.3 (5.4, 7.6) | 6.8 (5.6, 8) | 6.05 (5.2, 7.9) | 0.054 |
Lactate (mmol/l) | 1.4 (1, 2) | 1.3 (0.9, 1.9) | 1.7 (1.2, 2.58) | 1.4 (0.95, 1.85) | 0 |
P/F ratio | 260 (182, 348) | 268 (196, 350) | 227 (135, 320) | 251 (160.5330) | 0 |
Platelet (× 109/l) | 176 (115, 250) | 184 (124, 260) | 146 (82.25, 206.25) | 173 (108.75, 257) | 0 |
Total bilirubin (mmol/l) | 12 (7, 19) | 12 (7, 18) | 14 (8, 23) | 11 (8, 18.5) | 0.001 |
Mean blood pressure (mmHg) | 82 (72, 94) | 83 (73, 94) | 80 (70, 93) | 81 (70.5, 94.5) | 0.104 |
GCS score | 12 (7, 15) | 13 (7.75, 15) | 9 (5, 15) | 11 (6, 15) | 0 |
Serum creatinine (mmol/l) | 67 (48, 102.5) | 64 (47, 94) | 84 (55, 150) | 79.5 (55, 181.25) | 0 |
Urine output (ml/24 h) | 1800 (1100, 2468) | 1850 (1200, 2500) | 1500 (770, 2322.5) | 1800 (1007.5, 2400) | 0 |
SOFA score | 5 (3, 7) | 5 (3, 7) | 7 (5, 10) | 6 (4, 8) | 0 |
Body temperature (°C) | 37 (36.7, 37.7) | 37 (36.6, 37.6) | 37.2 (36.7, 38) | 37 (36.7, 37.52) | 0.002 |
Heart rate (/min) | 90 (80, 107) | 90 (79, 105) | 98 (85, 120) | 91 (80, 105) | 0 |
Respiratory rate (/min) | 20 (17, 24) | 20 (16, 24) | 20 (18, 26) | 20 (16, 23) | 0.003 |
White blood cell (× 109/l) | 10 (7.2, 13.7) | 9.8 (7.1, 13) | 11 (7.75, 15.3) | 10.2 (7.5, 14.55) | 0.001 |
APACHE II score | 17 (12, 22) | 16 (11, 21) | 20 (15, 26) | 19 (13, 23) | 0 |
EN start day | 1 (0, 3) | 1 (0, 2.5) | 1 (0, 2) | 1 (0, 3.75) | 0.099 |
EN in prior 24 h | 1270 (0.66) | 966 (0.67) | 206 (0.66) | 98 (0.65) | 0.951 |
AGI 1 | 1440 (0.86) | 1141 (0.88) | 214 (0.78) | 85 (0.79) | 0 |
AGI 2–3 | 210 (0.12) | 142 (0.11) | 51 (0.18) | 17 (0.16) | 0 |
AGI 4 | 33 (0.02) | 16 (0.01) | 11 (0.04) | 6 (0.06) | 0 |
Total volume of EN (ml) | 1000 (800, 1250) | 1000 (830, 1300) | 1000 (600, 1080) | 1000 (1000, 1225) | 0.203 |
Energy density of EN (kcal/ml) | 1 (1, 1.5) | 1 (1, 1.5) | 1 (1, 1.3) | 1 (1, 1.5) | 0.112 |
EN warming | 53 (0.04) | 37 (0.04) | 11 (0.06) | 5 (0.06) | 0.426 |
EN dilution | 538 (0.47) | 414 (0.48) | 87 (0.46) | 37 (0.47) | 0.944 |
EN route | |||||
Gastric | 1040 (0.85) | 783 (0.84) | 177 (0.88) | 80 (0.91) | 0.662 |
Jejunostomy | 10 (0.01) | 9 (0.01) | 1 (0) | 0 (0) | 0.662 |
PEG/J | 20 (0.02) | 19 (0.02) | 1 (0) | 0 (0) | 0.662 |
Postpyloric | 127 (0.1) | 101 (0.11) | 19 (0.1) | 7 (0.08) | 0.662 |
Other | 23 (0.02) | 20 (0.02) | 2 (0.01) | 1 (0.01) | 0.662 |
EN delivery method | |||||
Continuous pump | 1073 (0.88) | 821 (0.89) | 178 (0.88) | 74 (0.85) | 0.368 |
By gravity | 35 (0.03) | 27 (0.03) | 6 (0.03) | 2 (0.02) | 0.368 |
Intermittent | 86 (0.07) | 59 (0.06) | 17 (0.08) | 10 (0.11) | 0.368 |
Other | 22 (0.02) | 20 (0.02) | 1 (0) | 1 (0.01) | 0.368 |
Position | |||||
Bed head ≥30° | 1004 (0.83) | 771 (0.83) | 164 (0.82) | 69 (0.79) | 0.899 |
Bed head < 30° | 194 (0.16) | 143 (0.15) | 34 (0.17) | 17 (0.2) | 0.899 |
Sitting | 11 (0.01) | 9 (0.01) | 1 (0) | 1 (0.01) | 0.899 |
Other | 7 (0.01) | 6 (0.01) | 1 (0) | 0 (0) | 0.899 |
Frequency of GRV measurement | 2 (0, 4) | 3 (0, 4) | 2 (0, 4) | 3 (0, 6) | 0.353 |
Maximum GRV (ml) | 0 (0, 50) | 0 (0, 50) | 10 (0, 52.5) | 10 (0, 50) | 0.517 |
Use of gastrointestinal decompression | 334 (0.17) | 229 (0.16) | 76 (0.25) | 29 (0.18) | 0.001 |
Gastrointestinal decompression (ml) | 100 (40, 250) | 100 (40, 200) | 100 (50, 300) | 100 (30, 300) | 0.854 |
Abdominal pressure (mmHg) | 11.36 (8.27, 14.19) | 11.03 (8.82, 14) | 12.5 (9.43, 15.33) | 7.35 (5.88, 10) | 0.083 |
Duration of EN delivery (hours) | 20 (15, 24) | 20 (14, 24) | 21 (12, 24) | 24 (20, 24) | 0.001 |
EN discontinuation due to intolerance (times) | |||||
0 | 997 (0.95) | 775 (0.95) | 161 (0.93) | 61 (0.94) | 0.318 |
1 | 31 (0.03) | 21 (0.03) | 6 (0.03) | 4 (0.06) | 0.318 |
2 | 20 (0.02) | 15 (0.02) | 5 (0.03) | 0 (0) | 0.318 |
3 | 2 (0) | 1 (0) | 1 (0.01) | 0 (0) | 0.318 |
4 | 2 (0) | 1 (0) | 1 (0.01) | 0 (0) | 0.318 |
5 | 1 (0) | 1 (0) | 0 (0) | 0 (0) | 0.318 |
EN discontinuation due to examination (times) | |||||
0 | 950 (0.9) | 732 (0.9) | 156 (0.91) | 62 (0.95) | 0.13 |
1 | 84 (0.08) | 68 (0.08) | 14 (0.08) | 2 (0.03) | 0.13 |
2 | 11 (0.01) | 11 (0.01) | 0 (0) | 0 (0) | 0.13 |
3 | 1 (0) | 0 (0) | 0 (0) | 1 (0.02) | 0.13 |
4 | 1 (0) | 1 (0) | 0 (0) | 0 (0) | 0.13 |
5 | 2 (0) | 1 (0) | 1 (0.01) | 0 (0) | 0.13 |
6 | 2 (0) | 1 (0) | 1 (0.01) | 0 (0) | 0.13 |
EN discontinuation due to other reasons (times) | |||||
0 | 983 (0.95) | 753 (0.94) | 166 (0.96) | 64 (0.98) | 0.99 |
1 | 32 (0.03) | 27 (0.03) | 4 (0.02) | 1 (0.02) | 0.99 |
2 | 8 (0.01) | 7 (0.01) | 1 (0.01) | 0 (0) | 0.99 |
3 | 4 (0) | 3 (0) | 1 (0.01) | 0 (0) | 0.99 |
5 | 6 (0.01) | 5 (0.01) | 1 (0.01) | 0 (0) | 0.99 |
6 | 3 (0) | 3 (0) | 0 (0) | 0 (0) | 0.99 |
Presence of nausea | |||||
No | 1670 (0.86) | 1303 (0.88) | 260 (0.84) | 107 (0.69) | 0.000 |
Unable to judge | 176 (0.09) | 107 (0.07) | 32 (0.1) | 37 (0.24) | 0.000 |
Yes | 93 (0.05) | 63 (0.04) | 18 (0.06) | 12 (0.08) | 0.000 |
Presence of vomiting | |||||
No | 1743 (0.9) | 1338 (0.91) | 272 (0.87) | 133 (0.85) | 0.108 |
Suspected | 65 (0.03) | 44 (0.03) | 12 (0.04) | 9 (0.06) | 0.108 |
Unable to judge | 29 (0.01) | 21 (0.01) | 5 (0.02) | 3 (0.02) | 0.108 |
Yes | 105 (0.05) | 70 (0.05) | 23 (0.07) | 12 (0.08) | 0.108 |
Presence of aspiration | |||||
No | 1809 (0.94) | 1378 (0.94) | 296 (0.95) | 135 (0.87) | 0.008 |
Suspected | 87 (0.05) | 59 (0.04) | 11 (0.04) | 17 (0.11) | 0.008 |
Unable to judge | 20 (0.01) | 17 (0.01) | 1 (0) | 2 (0.01) | 0.008 |
Yes | 17 (0.01) | 12 (0.01) | 4 (0.01) | 1 (0.01) | 0.008 |
Presence of abdominal pain | |||||
No | 1436 (0.74) | 1133 (0.77) | 214 (0.69) | 89 (0.57) | 0 |
Persistent | 77 (0.04) | 51 (0.03) | 18 (0.06) | 8 (0.05) | 0 |
Self resolution | 93 (0.05) | 66 (0.04) | 15 (0.05) | 12 (0.08) | 0 |
Unable to judge | 329 (0.17) | 218 (0.15) | 63 (0.2) | 48 (0.31) | 0 |
Presence of abdominal distension | |||||
Mild | 420 (0.22) | 311 (0.21) | 66 (0.21) | 43 (0.27) | 0.000 |
No | 1347 (0.69) | 1055 (0.71) | 199 (0.64) | 93 (0.59) | 0.000 |
Obvious | 100 (0.05) | 60 (0.04) | 28 (0.09) | 12 (0.08) | 0.000 |
Severe | 18 (0.01) | 11 (0.01) | 6 (0.02) | 1 (0.01) | 0.000 |
Unable to judge | 62 (0.03) | 40 (0.03) | 13 (0.04) | 9 (0.06) | 0.000 |
Bowel sound | |||||
Hyper | 37 (0.02) | 27 (0.02) | 7 (0.02) | 3 (0.02) | 0 |
Hypo | 443 (0.23) | 295 (0.2) | 103 (0.33) | 45 (0.29) | 0 |
None | 125 (0.06) | 90 (0.06) | 22 (0.07) | 13 (0.08) | 0 |
Normal | 1321 (0.69) | 1047 (0.72) | 179 (0.58) | 95 (0.61) | 0 |
Stool | |||||
Yes | 1103 (0.58) | 840 (0.59) | 175 (0.57) | 88 (0.57) | 0.469 |
No | 579 (0.31) | 436 (0.31) | 98 (0.32) | 45 (0.29) | 0.469 |
No within 3 days | 171 (0.09) | 119 (0.08) | 33 (0.11) | 19 (0.12) | 0.469 |
Colostomy | 23 (0.01) | 19 (0.01) | 1 (0) | 3 (0.02) | 0.469 |
Incontinence | 16 (0.01) | 14 (0.01) | 2 (0.01) | 0 (0) | 0.469 |
Stool frequency | 1 (1, 2) | 1 (1, 2) | 1 (1, 2) | 2 (1, 2) | 0.943 |
Stool volume (ml) | 200 (100, 350) | 200 (100, 350) | 200 (100, 300) | 200 (100, 350) | 0.266 |
Stool description | |||||
Granular hard | 18 (0.02) | 15 (0.02) | 2 (0.01) | 1 (0.01) | 0.946 |
Loose | 528 (0.52) | 400 (0.52) | 92 (0.56) | 36 (0.52) | 0.946 |
Shaped | 2 (0) | 2 (0) | 0 (0) | 0 (0) | 0.946 |
Shaped soft | 412 (0.41) | 323 (0.42) | 61 (0.37) | 28 (0.41) | 0.946 |
Soft | 5 (0) | 4 (0.01) | 1 (0.01) | 0 (0) | 0.946 |
Watery | 45 (0.04) | 32 (0.04) | 9 (0.05) | 4 (0.06) | 0.946 |
Stool blood | |||||
Black stool | 16 (0.02) | 9 (0.01) | 7 (0.04) | 0 (0) | 0.174 |
Bloody stool | 5 (0) | 4 (0.01) | 1 (0.01) | 0 (0) | 0.174 |
No | 946 (0.94) | 731 (0.95) | 148 (0.91) | 67 (0.96) | 0.174 |
OB positive | 38 (0.04) | 28 (0.04) | 7 (0.04) | 3 (0.04) | 0.174 |
EN delivery
Factors associated with EN initiation
HR | 2.5% | 97.5% | p value | ||
---|---|---|---|---|---|
Source of admission (emergency room as reference) | Surgery | 1.087 | 0.878 | 1.346 | 0.443 |
Internal medicine | 1.166 | 0.935 | 1.455 | 0.174 | |
Other ward | 1.125 | 0.701 | 1.805 | 0.626 | |
Other hospital | 1.164 | 0.896 | 1.511 | 0.255 | |
Age | 1.002 | 0.997 | 1.007 | 0.371 | |
APACHE II score | 1.007 | 0.989 | 1.024 | 0.459 | |
SOFA score | 1.007 | 0.979 | 1.035 | 0.651 | |
Sex (female as reference) | 1.087 | 0.910 | 1.299 | 0.356 | |
AGI (AGI 1 as reference) | AGI 2–3 | 0.460 | 0.353 | 0.599 | < 0.001 |
AGI 4 | 0.056 | 0.008 | 0.398 | 0.004 | |
GCS score | 0.945 | 0.921 | 0.969 | < 0.001 |
Factors associated with proportion of EN delivery
Coefficient | 2.5% | 97.5% | p value | ||
---|---|---|---|---|---|
Age | – 0.002 | − 0.003 | − 0.001 | 0.039 | |
APACHE II score | 0.004 | − 0.001 | 0.009 | 0.114 | |
SOFA score | − 0.002 | − 0.008 | − 0.001 | 0.024 | |
Sex (female as reference) | − 0.144 | − 0.203 | − 0.085 | 0.000 | |
Source of admission (emergency room as reference) | Internal medicine | 0.036 | − 0.101 | 0.173 | 0.610 |
Other hospital | 0.040 | − 0.036 | 0.116 | 0.307 | |
Surgery | 0.023 | − 0.041 | 0.088 | 0.478 | |
Ward | − 0.026 | − 0.094 | 0.043 | 0.464 | |
EN start time (1-day increase) | − 0.006 | − 0.006 | − 0.012 | 0.001 | |
AGI (AGI 1 as reference) | AGI 2–3 | − 0.206 | − 0.273 | − 0.139 | 0.000 |
AGI 4 | − 0.370 | − 1.234 | 0.495 | 0.401 |