8498784f21f57d22ad90199b89431f47 283222.pdf 86a0633c0cb9af3295ccfe473a1351c78be7ca3e 283222.pdf bb0250357dfeef27551584387e73cafaa2252ec99c1c8d20865298adeda7710d 283222.pdf Title: The Effect of Enteral Immunonutrition in the Intensive Care Unit: Does It Impact on Outcomes? Subject: Background: The present research aimed to evaluate the effect on outcomes of immunonutrition (IMN) enteral formulas during the intensive care unit (ICU) stay. Methods: A multicenter prospective observational study was performed. Patient characteristics, disease severity, nutritional status, type of nutritional therapy and outcomes, and laboratory parameters were collected in a database. Statistical differences were analyzed according to the administration of IMN or other types of enteral formulas. Results: In total, 406 patients were included in the analysis, of whom 15.02% (61) received IMN. Univariate analysis showed that patients treated with IMN formulas received higher mean caloric and protein intake, and better 28-day survival (85.2% vs. 73.3%; p = 0.014. Unadjusted Hazard Ratio (HR): 0.15; 95% CI (Confidence Interval): 0.06–0.36; p < 0.001). Once adjusted for confounding factors, multivariate analysis showed a lower need for vasopressor support (OR: 0.49; 95% CI: 0.26–0.91; p = 0.023) and continuous renal replacement therapies (OR: 0.13; 95% CI: 0.01–0.65; p = 0.049) in those patients who received IMN formulas, independently of the severity of the disease. IMN use was also associated with higher protein intake during the administration of nutritional therapy (OR: 6.23; 95% CI: 2.59–15.54; p < 0.001), regardless of the type of patient. No differences were found in the laboratory parameters, except for a trend toward lower triglyceride levels (HR: 0.97; 95% CI: 0.95–0.99; p = 0.045). Conclusion: The use of IMN formulas may be associated with better outcomes (i.e., lower need for vasopressors and continuous renal replacement), together with a trend toward higher protein enteral delivery during the ICU stay. These findings may ultimately be related to their modulating effect on the inflammatory response in the critically ill. NCT Registry: 03634943. Keywords: enteral nutrition; immunonutrition; intensive care unit; protein delivery; outcomes; inflammatory response Author: Juan Carlos Lopez-Delgado, Teodoro Grau-Carmona, Javier Trujillano-Cabello, Carlos García-Fuentes, Esther Mor-Marco, Maria Luisa Bordeje-Laguna, Esther Portugal-Rodriguez, Carol Lorencio-Cardenas, Paula Vera-Artazcoz, Laura Macaya-Redin, Juan Francisco Martinez-Carmona, Lidón Mateu-Campos, Maria Gero-Escapa, Rosa Gastaldo-Simeon, Belen Vila-García, José Luis Flordelis-Lasierra, Juan Carlos Montejo-Gonzalez, Lluís Servia-Goixart and the ENPIC Study Group Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Sat May 7 11:17:54 2022 CEST ModDate: Sat May 7 11:20:37 2022 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 16 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1449568 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- XWOCXD+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 COTPVS+VnURWPalladioL Type 1 Custom yes yes no 15 0 QCHWOX+URWPalladioL-Bold Type 1 Custom yes yes no 19 0 NTOTQR+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 JMPXNM+URWPalladioL-Ital Type 1 Custom yes yes no 28 0 HGMNRX+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 46 0 HHHTKO+EURM10 Type 1 Builtin yes yes no 68 0 HLQYPB+CMSY10 Type 1 Builtin yes yes no 75 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes no 91 0 LBEDBO+Arial,Bold CID TrueType Identity-H yes yes yes 114 0 LBEDCA+Arial,BoldItalic TrueType WinAnsi yes yes no 120 0 LBCNJJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 123 0 LBCNJK+PalatinoLinotype CID TrueType Identity-H yes yes yes 126 0 LBCNJL+PalatinoLinotype TrueType WinAnsi yes yes no 132 0 LBCNKN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 135 0 LBDAFO+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 138 0 MPUDFL+PazoMath Type 1 Builtin yes yes no 148 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-11-08 02:30:03 CET RepresentationInformation: 283222.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-11-07 10:37:46 CET Size: 1449568 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 291 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@4d3167f4 Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@ed9d034 Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@6121c9d6 Children: Item: Title: Population Included in the Study Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@87f383f Item: Title: Univariate Analysis and Nutrition Delivery Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@4eb7f003 Item: Title: Outcome Results and Multivariate Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@eafc191 Item: Title: Subgroup Analysis by Type of Patients and Laboratory Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@612fc6eb Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1060b431 Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@612679d6 Item: Title: Appendix A Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@11758f2a Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@e720b71 Info: Title: The Effect of Enteral Immunonutrition in the Intensive Care Unit: Does It Impact on Outcomes? Author: Juan Carlos Lopez-Delgado, Teodoro Grau-Carmona, Javier Trujillano-Cabello, Carlos García-Fuentes, Esther Mor-Marco, Maria Luisa Bordeje-Laguna, Esther Portugal-Rodriguez, Carol Lorencio-Cardenas, Paula Vera-Artazcoz, Laura Macaya-Redin, Juan Francisco Martinez-Carmona, Lidón Mateu-Campos, Maria Gero-Escapa, Rosa Gastaldo-Simeon, Belen Vila-García, José Luis Flordelis-Lasierra, Juan Carlos Montejo-Gonzalez, Lluís Servia-Goixart and the ENPIC Study Group Subject: Background: The present research aimed to evaluate the effect on outcomes of immunonutrition (IMN) enteral formulas during the intensive care unit (ICU) stay. Methods: A multicenter prospective observational study was performed. Patient characteristics, disease severity, nutritional status, type of nutritional therapy and outcomes, and laboratory parameters were collected in a database. Statistical differences were analyzed according to the administration of IMN or other types of enteral formulas. Results: In total, 406 patients were included in the analysis, of whom 15.02% (61) received IMN. Univariate analysis showed that patients treated with IMN formulas received higher mean caloric and protein intake, and better 28-day survival (85.2% vs. 73.3%; p = 0.014. Unadjusted Hazard Ratio (HR): 0.15; 95% CI (Confidence Interval): 0.06 0.36; p < 0.001). Once adjusted for confounding factors, multivariate analysis showed a lower need for vasopressor support (OR: 0.49; 95% CI: 0.26 0.91; p = 0.023) and continuous renal replacement therapies (OR: 0.13; 95% CI: 0.01 0.65; p = 0.049) in those patients who received IMN formulas, independently of the severity of the disease. IMN use was also associated with higher protein intake during the administration of nutritional therapy (OR: 6.23; 95% CI: 2.59 15.54; p < 0.001), regardless of the type of patient. No differences were found in the laboratory parameters, except for a trend toward lower triglyceride levels (HR: 0.97; 95% CI: 0.95 0.99; p = 0.045). Conclusion: The use of IMN formulas may be associated with better outcomes (i.e., lower need for vasopressors and continuous renal replacement), together with a trend toward higher protein enteral delivery during the ICU stay. These findings may ultimately be related to their modulating effect on the inflammatory response in the critically ill. NCT Registry: 03634943. 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