Effect of early enteral nutrition on patients with sepsis based on grading of acute gastrointestinal injury and its impact on short-term prognosis
Objective Investigate the effect of early enteral nutrition(EN)guided by acute gastrointestinal injury(AGI)grading on septic patients and its impact on short-term prognosis.Methods A retrospective analysis was conducted on 102 septic patients admitted to 14 comprehensive ICUs from March 2014 to August 2014 in Zhejiang.Participants were categorized into four groups based on their highest AGI grade during the first week of admission:non-AGI group,AGI gradeⅠ group,AGI grade Ⅱ group,and AGI grade Ⅲ+Ⅳ group.Baseline data,including Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)Score,Sequential Organ Failure Assessment(SOFA)Score,and mean arterial pressure(MAP),as well as other indicators such as the 28-day hospital survival rate,duration of mechanical ventilation-free days,duration of antibiotic use,and the proportion of patients achieving EN caloric targets within 7 days of admission were compared among the groups.Survival rates among septic patients with different AGI grades were assessed using Kaplan-Meier survival curves and log-rank tests.Independent influence factors for survival prognosis in septic patients were identified using a Cox proportional hazards regression model.Results Significant differences were observed in APACHE Ⅱ Score,SOFA Score,MAP,lactic acid,duration of mechanical ventilation-free days,and duration of antibiotic use among the four groups(all P＜0.05).Patients with AGI had a lower 28-day hospital survival rate than those without AGI,and survival rates decreased with increasing AGI grades,with significant differences(all P＜0.05).Patients who met EN caloric targets on the 3rd and 7th days after admission had significantly higher 28-day hospital survival rates than those who did not,with significant differences(P＜0.05).Cox regression analysis identified lactate levels(HR=1.180,95％CI:1.045-1.340,P=0.008),AGI grading(HR=1.304,95％CI:1.041-1.567,P=0.012),APACHE Ⅱ Score(HR=1.069,95％CI:1.013-1.129,P=0.015),and SOFA Score(HR=1.183,95％CI:1.040-1.330,P=0.005)as independent risk factors for mortality in septic patients,whereas MAP(HR=0.969,95％CI:0.949-0.989,P=0.003)and achieving EN caloric targets by the 7th day of admission(HR=0.458,95％CI:0.225-0.930,P=0.031)were identified as protective factors.Conclusion Early enteral nutrition in septic patients based on AGI grading has certain clinical significance.Higher AGI grades are predictors of increased mortality rates,whereas early achievement of target EN caloric intake reduces mortality in septic patients.
万方数据
维普
