Effect of nutritional support in patients with lower respiratory tract infection: Secondary analysis of a randomized clinical trial.
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BORIS DOI
Publisher DOI
PubMed ID
33081983
Description
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.
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.
Date of Publication
2021-04
Publication Type
article
Subject(s)
600 - Technology::610 - Medicine & health
300 - Social sciences, sociology & anthropology::360 - Social problems & social services
Keyword(s)
COVID19 Malnutrition Nutritional support Outcome Randomized trial Respiratory infection
Language(s)
en
Contributor(s)
Baumgartner, Annic | |
Hasenboehler, Flavia | |
Cantone, Jennifer | |
Hersberger, Lara | |
Bargetzi, Annika | |
Bargetzi, Laura | |
Kaegi-Braun, Nina | |
Tribolet, Pascal | |
Gomes, Filomena | |
Hoess, Claus | |
Pavlicek, Vojtech | |
Bilz, Stefan | |
Sigrist, Sarah | |
Brändle, Michael | |
Henzen, Christoph | |
Thomann, Robert | |
Rutishauser, Jonas | |
Mueller, Beat | |
Schuetz, Philipp |
Additional Credits
Universitätsklinik für Allgemeine Innere Medizin
Berner Institut für Hausarztmedizin (BIHAM)
Universitätsklinik für Diabetologie, Endokrinologie, Ernährungsmedizin & Metabolismus (UDEM)
Series
Clinical nutrition
Publisher
Elsevier
ISSN
0261-5614
Access(Rights)
open.access