Early Enteral Nutrition and Sepsis-Associated Acute Kidney Injury: A Propensity Score Matched Cohort Study Based on the MIMIC-III Database
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: We aimed to analyze the optimal timing of enteral nutrition (EN) in the treatment of sepsis and its effect on sepsis-asso ciated acute kidney injury (SA-AKI.)Materials and Methods: The MIMIC-III database was employed to identify patients with sepsis who had received EN. With AKI as the primary outcome variable, receiver operating characteristic (ROC) curves were utilized to calculate the optimal cut-off time of early EN (EEN). Propensity score matching (PSM) was employed to control confounding effects. Logistic regressions and propen sity score-based inverse probability of treatment weighting were utilized to assess the robustness of our findings. Comparisons within the EEN group were performed. Results: 2364 patients were included in our study. With 53 hours after intensive care units (ICU) admission as the cut-off time of EEN according to the ROC curve, 1212 patients were assigned to the EEN group and the other 1152 to the delayed EN group. The risk of SA-AKI was reduced in the EEN group (odds ratio 0.319, 95% confidence interval 0.245–0.413, p<0.001). The EEN patients re ceived fewer volumes (mL) of intravenous fluid (IVF) during their ICU stay (3750 mL vs. 5513.23 mL, p<0.001). The mediating ef fect of IVF was significant (p<0.001 for the average causal mediation effect). No significant differences were found within the EEN group (0–48 hours vs. 48–53 hours), except that patients initiating EN within 48 hours spent fewer days in ICU and hospital. Conclusion: EEN is associated with decreased risk of SA-AKI, and this beneficial effect may be proportionally mediated by IVF volume.
Abstract
Purpose: We aimed to analyze the optimal timing of enteral nutrition (EN) in the treatment of sepsis and its effect on sepsis-asso ciated acute kidney injury (SA-AKI.)Materials and Methods: The MIMIC-III database was employed to identify patients with sepsis who had received EN. With AKI as the primary outcome variable, receiver operating characteristic (ROC) curves were utilized to calculate the optimal cut-off time of early EN (EEN). Propensity score matching (PSM) was employed to control confounding effects. Logistic regressions and propen sity score-based inverse probability of treatment weighting were utilized to assess the robustness of our findings. Comparisons within the EEN group were performed. Results: 2364 patients were included in our study. With 53 hours after intensive care units (ICU) admission as the cut-off time of EEN according to the ROC curve, 1212 patients were assigned to the EEN group and the other 1152 to the delayed EN group. The risk of SA-AKI was reduced in the EEN group (odds ratio 0.319, 95% confidence interval 0.245–0.413, p<0.001). The EEN patients re ceived fewer volumes (mL) of intravenous fluid (IVF) during their ICU stay (3750 mL vs. 5513.23 mL, p<0.001). The mediating ef fect of IVF was significant (p<0.001 for the average causal mediation effect). No significant differences were found within the EEN group (0–48 hours vs. 48–53 hours), except that patients initiating EN within 48 hours spent fewer days in ICU and hospital. Conclusion: EEN is associated with decreased risk of SA-AKI, and this beneficial effect may be proportionally mediated by IVF volume.
참고문헌 (36)
- Kadri SS, "Estimating ten-year trends in septic shock incidence and mortality in United States academic medical centers using clinical data", Chest, 151, pp.278~285 (2017)
- Rhodes A, "Surviving sepsis campaign : international guidelines for management of sepsis and septic shock : 2016", Intensive Care Med, 43, pp.304~377 (2017)
- Uchino S, "Acute renal failure in critically ill patients : a multinational, multicenter study", JAMA, 294, pp.813~818 (2005)
- Bouchard J, "A prospective international multicenter study of AKI in the intensive care unit", Clin J Am Soc Nephrol, 10, pp.1324~1331 (2015)
- Murugan R, "Acute kidney injury : what’s the prognosis?", Nat Rev Nephrol, 7, pp.209~217 (2011)
- Hoste EA, "Epidemiology of acute kidney injury in critically ill patients : the multinational AKI-EPI study", Intensive Care Med, 41, pp.1411~1423 (2015)
- Dvorak MF, "Early versus late enteral feeding in patients with acute cervical spinal cord injury : a pilot study", Spine(Phila Pa 1976), 29, pp.E175~80 (2004)
- Eyer SD, "Early enteral feeding does not attenuate metabolic response after blunt trauma", J Trauma, 34, pp.639~643 (1993)
- Grahm TW, "The benefits of early jejunal hyperalimentation in the head-injured patient", Neurosurgery, 25, pp.729~735 (1989)
- Hasse JM, "Early enteral nutrition support in patients undergoing liver transplantation", J Parenter Enteral Nutr, 19, pp.437~443 (1995)
- Minard G, "Early versus delayed feeding with an immune-enhancing diet in patients with severe head injuries", J Parenter Enteral Nutr, 24, pp.145~149 (2000)
- Moore EE, "Benefits of immediate jejunostomy feeding after major abdominal trauma--a prospective, randomized study", J Trauma, 26, pp.874~881 (1986)
- Nguyen NQ, "The impact of delaying enteral feeding on gastric emptying, plasma cholecystokinin, and peptide YY concentrations in critically ill patients", Crit Care Med, 36, pp.1469~1474 (2008)
- Peng YZ, "Effects of early enteral feeding on the prevention of enterogenic infection in severely burned patients", Burns, 27, pp.145~149 (2001)
- Singh G, "Early postoperative enteral feeding in patients with nontraumatic intestinal perforation and peritonitis", J Am Coll Surg, 187, pp.142~146 (1998)
- Chourdakis M, "Effect of early compared with delayed enteral nutrition on endocrine function in patients with traumatic brain injury : an open-labeled randomized trial", J Parenter Enteral Nutr, 36, pp.108~116 (2012)
- Johnson AE, "MIMIC-III, a freely accessible critical care database", Sci Data, 3, pp.160035~ (2016)
- von Elm E, "The strengthening the reporting of observational studies in epidemiology(STROBE)statement : guidelines for reporting observational studies", Lancet, 370, pp.1453~1457 (2007)
- Angus DC, "Epidemiology of severe sepsis in the United States : analysis of incidence, outcome, and associated costs of care", Crit Care Med, 29, pp.1303~1310 (2001)
- Kellum JA, "Kidney disease : improving global outcomes(KDIGO)acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury", Kidney Int Suppl, 17, pp.1~138 (2012)
- Le Gall JR, "A new simplified acute physiology score(SAPS II)based on a European", North American multicenter study, 1993, pp.270, 2957~2963
- Vincent JL, "The SOFA(sepsis-related organ failure assessment)score to describe organ dysfunction", failure. On behalf of the working group on sepsis-related problems of the European Society of Intensive Care Medicine, 1996, pp.22, 707~710
- van Walraven C, "A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data", Med Care, 47, pp.626~633 (2009)
- van Buuren S, "Mice : Multivariate Imputation by Chained Equations in R", Journal of Statistical Software, 45, pp.1~67 (2011)
- Ho DE, "Matching as nonparametric preprocessing for reducing model dependence in parametric causal inference", Political Anal, 15, pp.199~236 (2007)
- Tingley D, "Mediation : R Package for Causal Mediation Analysis", J Stat Soft, 59, pp.1~38 (2014)
- "WeightIt: weighting for covariate balance in observational studies (version: 0.10.2)"[URL]
- Chen H, "Central venous pressure measurement is associated with improved outcomes in septic patients : an analysis of the MIMIC-III database", Crit Care, 24, pp.433~ (2020)
- Hu J, "Effect of hypoproteinemia on the mortality of sepsis patients in the ICU : a retrospective cohort study", Sci Rep, 11, pp.24379~ (2021)
- Hoste EA, "RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients : a cohort analysis", Crit Care, 10, pp.R73~ (2006)
- Uchino S, "An assessment of the RIFLE criteria for acute renal failure in hospitalized patients", Crit Care Med, 34, pp.1913~1917 (2006)
- Bagshaw SM, "A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients", Nephrol Dial Transplant, 23, pp.1203~1210 (2008)
- Thakar CV, "Incidence and outcomes of acute kidney injury in intensive care units : a veterans administration study", Crit Care Med, 37, pp.2552~2558 (2009)
- Joannidis M, "Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database", Intensive Care Med, 35, pp.1692~1702 (2009)
- Ali T, "Incidence and outcomes in acute kidney injury : a comprehensive population-based study", J Am Soc Nephrol, 18, pp.1292~1298 (2007)
- Honore PM, "Prevention and treatment of sepsis-induced acute kidney injury : an update", Ann Intensive Care, 5, pp.51~ (2015)