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Effect of supplemental parenteral nutrition on all-cause mortality in critically Ill adults: A meta-analysis and subgroup analysis

OBJECTIVE: Several observational studies have demonstrated that increased nutritional delivery by supplemental parenteral nutrition (SPN) plus enteral nutrition (EN) reduces the rate of all-cause mortality in critically ill patients. Therefore, we aimed to compare and evaluate the effect of SPN plus...

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Autores principales: Li, Peng, Zhong, ChunYan, Qiao, ShiBin, Liu, JunJun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9441914/
https://www.ncbi.nlm.nih.gov/pubmed/36071935
http://dx.doi.org/10.3389/fnut.2022.897846
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author Li, Peng
Zhong, ChunYan
Qiao, ShiBin
Liu, JunJun
author_facet Li, Peng
Zhong, ChunYan
Qiao, ShiBin
Liu, JunJun
author_sort Li, Peng
collection PubMed
description OBJECTIVE: Several observational studies have demonstrated that increased nutritional delivery by supplemental parenteral nutrition (SPN) plus enteral nutrition (EN) reduces the rate of all-cause mortality in critically ill patients. Therefore, we aimed to compare and evaluate the effect of SPN plus EN on all-cause mortality in critically ill adults. METHODS: Randomized controlled trials were retrieved from PubMed, Embase, Google Scholar, Cochrane Library, and Sinomed (up to May 2021). Adults with severe illness treated with SPN plus EN or with EN alone were enrolled. The risk of bias was evaluated using the Newcastle–Ottawa scale, and a meta-analysis was conducted using Stata software. The primary outcome was all-cause mortality and was evaluated by pooled odds ratio (OR) with the fixed-effects model. Required information size was also calculated using trial sequential analysis. RESULTS: We identified 10 randomized controlled trials, with a total of 6,908 patients. No significant differences in rate of all-cause mortality (OR = 0.96, 95% CI: 0.84–1.09, P = 0.518), intensive care unit (ICU) mortality (OR = 0.90, 95% CI: 0.75–1.07, P = 0.229), and hospital mortality (OR = 0.95, 95% CI: 0.82–1.10, P = 0.482) were found between the SPN plus EN and EN alone groups. SPN plus EN support was associated with a significantly decreased risk of infection (OR = 0.83, 95% CI: 0.74–0.93, P = 0.001), although the duration of mechanical ventilation [standardized mean difference (SMD) = − 0.20], length of hospital stay (SMD = 0.12), and ICU stay (SMD = − 0.57) were similar between the two groups (all P > 0.05). Meta-regression analyses showed no significant correlations between all-cause mortality and baseline clinical factors, including patients’ age, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, time of SPN initiation, and follow-up duration (all P > 0.05). Subgroup analysis showed that SPN plus EN support was associated with a trend toward decreased rate of all-cause mortality in studies with follow-up < 30 days (OR = 0.61, 95% CI: 0.36–1.02, P = 0.058). Trial sequence analysis showed that the required information size for all-cause mortality was 16,972, and the cumulative Z-curve indicated no significant differences in the risk of all-cause mortality between the two groups (P > 0.05). CONCLUSION: SPN plus EN support can significantly reduce the risk of infection, although it has no significant effect on all-cause mortality among critically ill patients. More studies are warranted to confirm these findings.
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spelling pubmed-94419142022-09-06 Effect of supplemental parenteral nutrition on all-cause mortality in critically Ill adults: A meta-analysis and subgroup analysis Li, Peng Zhong, ChunYan Qiao, ShiBin Liu, JunJun Front Nutr Nutrition OBJECTIVE: Several observational studies have demonstrated that increased nutritional delivery by supplemental parenteral nutrition (SPN) plus enteral nutrition (EN) reduces the rate of all-cause mortality in critically ill patients. Therefore, we aimed to compare and evaluate the effect of SPN plus EN on all-cause mortality in critically ill adults. METHODS: Randomized controlled trials were retrieved from PubMed, Embase, Google Scholar, Cochrane Library, and Sinomed (up to May 2021). Adults with severe illness treated with SPN plus EN or with EN alone were enrolled. The risk of bias was evaluated using the Newcastle–Ottawa scale, and a meta-analysis was conducted using Stata software. The primary outcome was all-cause mortality and was evaluated by pooled odds ratio (OR) with the fixed-effects model. Required information size was also calculated using trial sequential analysis. RESULTS: We identified 10 randomized controlled trials, with a total of 6,908 patients. No significant differences in rate of all-cause mortality (OR = 0.96, 95% CI: 0.84–1.09, P = 0.518), intensive care unit (ICU) mortality (OR = 0.90, 95% CI: 0.75–1.07, P = 0.229), and hospital mortality (OR = 0.95, 95% CI: 0.82–1.10, P = 0.482) were found between the SPN plus EN and EN alone groups. SPN plus EN support was associated with a significantly decreased risk of infection (OR = 0.83, 95% CI: 0.74–0.93, P = 0.001), although the duration of mechanical ventilation [standardized mean difference (SMD) = − 0.20], length of hospital stay (SMD = 0.12), and ICU stay (SMD = − 0.57) were similar between the two groups (all P > 0.05). Meta-regression analyses showed no significant correlations between all-cause mortality and baseline clinical factors, including patients’ age, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, time of SPN initiation, and follow-up duration (all P > 0.05). Subgroup analysis showed that SPN plus EN support was associated with a trend toward decreased rate of all-cause mortality in studies with follow-up < 30 days (OR = 0.61, 95% CI: 0.36–1.02, P = 0.058). Trial sequence analysis showed that the required information size for all-cause mortality was 16,972, and the cumulative Z-curve indicated no significant differences in the risk of all-cause mortality between the two groups (P > 0.05). CONCLUSION: SPN plus EN support can significantly reduce the risk of infection, although it has no significant effect on all-cause mortality among critically ill patients. More studies are warranted to confirm these findings. Frontiers Media S.A. 2022-08-22 /pmc/articles/PMC9441914/ /pubmed/36071935 http://dx.doi.org/10.3389/fnut.2022.897846 Text en Copyright © 2022 Li, Zhong, Qiao and Liu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Nutrition
Li, Peng
Zhong, ChunYan
Qiao, ShiBin
Liu, JunJun
Effect of supplemental parenteral nutrition on all-cause mortality in critically Ill adults: A meta-analysis and subgroup analysis
title Effect of supplemental parenteral nutrition on all-cause mortality in critically Ill adults: A meta-analysis and subgroup analysis
title_full Effect of supplemental parenteral nutrition on all-cause mortality in critically Ill adults: A meta-analysis and subgroup analysis
title_fullStr Effect of supplemental parenteral nutrition on all-cause mortality in critically Ill adults: A meta-analysis and subgroup analysis
title_full_unstemmed Effect of supplemental parenteral nutrition on all-cause mortality in critically Ill adults: A meta-analysis and subgroup analysis
title_short Effect of supplemental parenteral nutrition on all-cause mortality in critically Ill adults: A meta-analysis and subgroup analysis
title_sort effect of supplemental parenteral nutrition on all-cause mortality in critically ill adults: a meta-analysis and subgroup analysis
topic Nutrition
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9441914/
https://www.ncbi.nlm.nih.gov/pubmed/36071935
http://dx.doi.org/10.3389/fnut.2022.897846
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