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Randomized Controlled Trial
. 2021 Apr;40(4):1843-1850.
doi: 10.1016/j.clnu.2020.10.009. Epub 2020 Oct 10.

Effect of nutritional support in patients with lower respiratory tract infection: Secondary analysis of a randomized clinical trial

Annic Baumgartner  1 , Flavia Hasenboehler  1 , Jennifer Cantone  1 , Lara Hersberger  1 , Annika Bargetzi  1 , Laura Bargetzi  1 , Nina Kaegi-Braun  2 , Pascal Tribolet  3 , Filomena Gomes  4 , Claus Hoess  5 , Vojtech Pavlicek  5 , Stefan Bilz  6 , Sarah Sigrist  6 , Michael Brändle  6 , Christoph Henzen  7 , Robert Thomann  8 , Jonas Rutishauser  9 , Drahomir Aujesky  10 , Nicolas Rodondi  11 , Jacques Donzé  12 , Zeno Stanga  13 , Beat Mueller  1 , Philipp Schuetz  14
Affiliations
Randomized Controlled Trial

Effect of nutritional support in patients with lower respiratory tract infection: Secondary analysis of a randomized clinical trial

Annic Baumgartner et al. Clin Nutr. 2021 Apr.

Abstract

Background: In polymorbid patients with bronchopulmonary infection, malnutrition is an independent risk factor for mortality. There is a lack of interventional data investigating whether providing nutritional support during the hospital stay in patients at risk for malnutrition presenting with lower respiratory tract infection lowers mortality.

Methods: For this secondary analysis of a randomized clinical trial (EFFORT), we analyzed data of a subgroup of patients with confirmed lower respiratory tract infection from an initial cohort of 2028 patients. Patients at nutritional risk (Nutritional Risk Screening [NRS] score ≥3 points) were randomized to receive protocol-guided individualized nutritional support to reach protein and energy goals (intervention group) or standard hospital food (control group). The primary endpoint of this analysis was all-cause 30-day mortality.

Results: We included 378 of 2028 EFFORT patients (mean age 74.4 years, 24% with COPD) into this analysis. Compared to usual care hospital nutrition, individualized nutritional support to reach caloric and protein goals showed a similar beneficial effect of on the risk of mortality in the subgroup of respiratory tract infection patients as compared to the main EFFORT trial (odds ratio 0.47 [95%CI 0.17 to 1.27, p = 0.136] vs 0.65 [95%CI 0.47 to 0.91, p = 0.011]) with no evidence of a subgroup effect (p for interaction 0.859). Effects were also similar among different subgroups based on etiology and type of respiratory tract infection and for other secondary endpoints.

Conclusion: This subgroup analysis from a large nutrition support trial suggests that patients at nutritional risk as assessed by NRS 2002 presenting with bronchopulmonary infection to the hospital likely have a mortality benefit from individualized inhospital nutritional support. The small sample size and limited statistical power calls for larger nutritional studies focusing on this highly vulnerable patient population.

Clinical trial registration: Registered under ClinicalTrials.gov Identifier no. NCT02517476.

Keywords: COVID19; Malnutrition; Nutritional support; Outcome; Randomized trial; Respiratory infection.

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Conflict of interest statement

Conflict of interest The study was investigator-initiated and supported by a grant from the Swiss National Science Foundation to P.Schuetz (SNSF Professorship, PP00P3_150531) and the Forschungsrat of the Kantonsspital Aarau (1410.000.058 and 1410.000.044). The institution of P.Schuetz has previously received unrestricted grant money unrelated to this project from Neste Health Science and Abbott Nutrition. The institution of Z.Stanga received speaking honoraria and research support from Neste Health Science, Abbott Nutrition and Fresenius Kabi. All other authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
Patient flow.
Fig. 2
Fig. 2
Odds ratios for primary and secondary outcomes in pre-specified subgroups (Forest plot). Abbreviations: COPD = chronic obstructive pulmonary disease, GOLD = Global Initiative for Chronic Obstructive Lung Disease.
See this image and copyright information in PMC

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