TY - JOUR
T1 - Associations between enteral nutrition and outcomes in the SUP-ICU trial
T2 - Results of exploratory post hoc analyses
AU - Borthwick, Mark
AU - Granholm, Anders
AU - Marker, Søren
AU - Krag, Mette
AU - Lange, Theis
AU - Wise, Matt P.
AU - Bendel, Stepani
AU - Keus, Frederik
AU - Guttormsen, Anne Berit
AU - Schefold, Joerg C.
AU - Wetterslev, Jørn
AU - Perner, Anders
AU - Møller, Morten Hylander
N1 - Publisher Copyright:
© 2024 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.
PY - 2024/10
Y1 - 2024/10
N2 - Background: Enteral nutrition may affect risks of gastrointestinal bleeding, pneumonia and mortality in critically ill patients and may also modify the effects of pharmacological stress ulcer prophylaxis. We undertook post hoc analyses of the stress ulcer prophylaxis in the intensive care unit trial to assess for any associations and interactions between enteral nutrition and pantoprazole. Methods: Extended Cox models with time-varying co-variates and competing events were used to assess potential associations, adjusted for baseline severity of illness. Potential interactions between daily enteral nutrition and allocation to pantoprazole on outcomes were similarly assessed. Results: Enteral nutrition was associated with lower risk of clinically important gastrointestinal bleeding (cause-specific hazard ratio [HR]: 0.29, 95% confidence interval: [CI] 0.19–0.44, p <.001), higher risk of pneumonia (HR: 1.44, 95% CI: 1.14–1.82, p =.003), and lower risk of all-cause mortality (HR: 0.22, 95% CI: 0.18–0.27, p <.001). Enteral nutrition with allocation to pantoprazole was associated with a lower risk of mortality (HR: 0.27, 95% CI: 0.21–0.35, p <.001), similar to enteral nutrition with allocation to placebo (HR: 0.17, 95% CI: 0.13–0.23, p <.001). Allocation to pantoprazole with no enteral nutrition had little effect on mortality (HR: 0.83, 95% CI: 0.63–1.09, p =.179), whilst allocation to pantoprazole and receipt of enteral nutrition was mostly compatible with increased all-cause mortality (HR: 1.27, 95% CI: 0.99–1.64, p =.061). The test of interaction between enteral nutrition and pantoprazole treatment allocation for all-cause mortality was statistically significant (p =.024). Conclusions: Enteral nutrition was associated with an increased risk of pneumonia and a reduced risk of gastrointestinal bleeding. The interaction between pantoprazole and enteral nutrition suggesting an increased risk of mortality requires further study.
AB - Background: Enteral nutrition may affect risks of gastrointestinal bleeding, pneumonia and mortality in critically ill patients and may also modify the effects of pharmacological stress ulcer prophylaxis. We undertook post hoc analyses of the stress ulcer prophylaxis in the intensive care unit trial to assess for any associations and interactions between enteral nutrition and pantoprazole. Methods: Extended Cox models with time-varying co-variates and competing events were used to assess potential associations, adjusted for baseline severity of illness. Potential interactions between daily enteral nutrition and allocation to pantoprazole on outcomes were similarly assessed. Results: Enteral nutrition was associated with lower risk of clinically important gastrointestinal bleeding (cause-specific hazard ratio [HR]: 0.29, 95% confidence interval: [CI] 0.19–0.44, p <.001), higher risk of pneumonia (HR: 1.44, 95% CI: 1.14–1.82, p =.003), and lower risk of all-cause mortality (HR: 0.22, 95% CI: 0.18–0.27, p <.001). Enteral nutrition with allocation to pantoprazole was associated with a lower risk of mortality (HR: 0.27, 95% CI: 0.21–0.35, p <.001), similar to enteral nutrition with allocation to placebo (HR: 0.17, 95% CI: 0.13–0.23, p <.001). Allocation to pantoprazole with no enteral nutrition had little effect on mortality (HR: 0.83, 95% CI: 0.63–1.09, p =.179), whilst allocation to pantoprazole and receipt of enteral nutrition was mostly compatible with increased all-cause mortality (HR: 1.27, 95% CI: 0.99–1.64, p =.061). The test of interaction between enteral nutrition and pantoprazole treatment allocation for all-cause mortality was statistically significant (p =.024). Conclusions: Enteral nutrition was associated with an increased risk of pneumonia and a reduced risk of gastrointestinal bleeding. The interaction between pantoprazole and enteral nutrition suggesting an increased risk of mortality requires further study.
KW - critical illness
KW - enteral feeding
KW - gastrointestinal bleeding
KW - mortality
KW - pneumonia
KW - proton pump inhibitor
UR - http://www.scopus.com/inward/record.url?scp=85195954890&partnerID=8YFLogxK
U2 - 10.1111/aas.14471
DO - 10.1111/aas.14471
M3 - Article
AN - SCOPUS:85195954890
SN - 0001-5172
VL - 68
SP - 1244
EP - 1253
JO - Acta Anaesthesiologica Scandinavica
JF - Acta Anaesthesiologica Scandinavica
IS - 9
ER -