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Observational Study
. 2025 Apr 29;25(1):628.
doi: 10.1186/s12879-025-10912-8.

Association between early enteral nutrition and 28-Day mortality in mechanically ventilated patients with sepsis: a retrospective analysis of the MIMIC-IV database

Fuchao Xu  1 , Geng Lu  1 , Hao Sun  2 , Jun Wang  3
Affiliations
Observational Study

Association between early enteral nutrition and 28-Day mortality in mechanically ventilated patients with sepsis: a retrospective analysis of the MIMIC-IV database

Fuchao Xu et al. BMC Infect Dis. .

Abstract

Background: The optimal timing of enteral nutrition for critically ill septic patients in the intensive care unit (ICU) who require invasive mechanical ventilation has not been determined, and the influence of early enteral nutrition on clinical outcomes is unclear.

Methods: This retrospective observational study utilized data from the Medical Information Mart for Intensive Care IV 2.2 (MIMIC-IV 2.2) database to investigate patients with sepsis who needed invasive mechanical ventilation post-ICU admission. Patients who had enteral nutrition (EN) initiated within 72 h of ICU were categorized into the early enteral nutrition (EEN) group, while those who began enteral nutrition after 72 h were placed in the delayed enteral nutrition (DEN) group. Propensity score matching analysis was performed to compare outcomes between these two groups, with the primary outcome being 28-day mortality.

Results: The final analysis included 2293 patients, 1546 (67.4%) of whom received enteral nutrition within 72 h of invasive mechanical ventilation. The overall 28-day mortality rate was 31.0%. After propensity score matching employing the proximity matching method, Cox survival analysis revealed that early enteral nutrition was associated with increased 28-day mortality in septic patients on invasive mechanical ventilation (hazard ratio(HR) 1.440, 95% CI 1.179-1.760; p < 0.001). The sensitivity and robustness of the evaluation results under different models, including optimal matching (adjusted odds ratio (aOR) 1.52, 95% CI 1.21-1.92, p < 0.001), inverse probability of treatment weighting (aOR 1.27, 95% CI 1.02-1.58, p = 0.034), and logistic regression analysis (aOR 1.48, 95% CI 1.18-1.84, p = 0.001), confirmed the association between early enteral nutrition and increased 28-day mortality in mechanically ventilated septic patients.

Conclusions: Compared to delayed enteral nutrition, early enteral nutrition is associated with higher 28-day mortality in septic patients on invasive mechanical ventilation. Randomized controlled trials are warranted to validate these findings.

Keywords: Enteral nutrition; ICU; Invasive mechanical ventilation; MIMIC-IV; Sepsis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Massachusetts Institute of Technology Institutional Review Board approves the MIMIC IV database. All the database patients are de-identified for privacy protection and the Nanjing Drum Tower Hospital Ethics Committee waives informed consent. The study followed the principles of the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The flow diagram of study patients
Fig. 2
Fig. 2
K-M survival curve of 28-day mortality between the EEN group and EDN group after matching using the 1:1 nearest matching method
Fig. 3
Fig. 3
The relationship between EEN and 28-day mortality under different models. (IPTW, Inverse Probability of Treatment Weighting; Logistic Reg, Logistic Regression Analysis; NNM, Nearest Neighbor Matching; OM, Optimal Matching)
Fig. 4
Fig. 4
Subgroup analysis results after IPTW removes extreme values
See this image and copyright information in PMC

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References

    1. Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard G, Chiche J, Coopersmith C, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801–10. - PMC - PubMed
    1. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, Machado FR, McIntyre L, Ostermann M, Prescott HC, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181–247. - PMC - PubMed
    1. Fleischmann-Struzek C, Mellhammar L, Rose N, Cassini A, Rudd K, Schlattmann P, Allegranzi B, Reinhart K. Incidence and mortality of hospital- and ICU-treated sepsis: results from an updated and expanded systematic review and meta-analysis. Intensive Care Med. 2020;46(8):1552–62. - PMC - PubMed
    1. Adelman M, Woodworth M, Langelier C, Busch L, Kempker J, Kraft C, Martin G. The gut microbiome’s role in the development, maintenance, and outcomes of sepsis. Critical care (London, England). 2020;24(1):278. - PMC - PubMed
    1. Haak B, Prescott H, Wiersinga W. Therapeutic Potential of the Gut Microbiota in the Prevention and Treatment of Sepsis. Front Immunol. 2018;9:2042. - PMC - PubMed

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