EPaNIC (2-year follow-up)
Trial question
What is the role of late initiation of parenteral nutrition to supplement insufficient enteral nutrition in critically ill patients?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
36.0% female
64.0% male
N = 4640
4640 patients (1668 female, 2972 male).
Inclusion criteria: adult patients in the ICU who had a score of ≥ 3 on nutritional risk screening.
Key exclusion criteria: age < 18 years; moribund; DNR order; short bowel syndrome; home ventilation; diabetic coma; pregnancy or lactation; receipt of oral nutrition; BMI < 17 kg/m²; nutritional risk screening score < 3.
Interventions
N=2328 late parenteral initiation (parenteral nutrition not initiated before day 8).
N=2312 early parenteral initiation (parenteral nutrition initiated within 48 hours after ICU admission).
Primary outcome
All-cause mortality at 2 years
20.5%
19.8%
20.5 %
15.4 %
10.3 %
5.1 %
0.0 %
Late parenteral
initiation
Early parenteral
initiation
No significant
difference ↔
No significant difference in all-cause mortality at 2 years (20.5% vs. 19.8%; RR 1.04, 95% CI -2.2 to 4.28).
Safety outcomes
No significant differences in 36-Item Short Form Survey physical functioning, physical component, and mental component scores at 2 years.
Conclusion
In adult patients in the ICU who had a score of ≥ 3 on nutritional risk screening, late parenteral initiation was not superior to early parenteral initiation with respect to all-cause mortality at 2 years.
Reference
Michael P Casaer, Hendrik Stragier, Greet Hermans et al. Impact of withholding early parenteral nutrition on 2-year mortality and functional outcome in critically ill adults. Intensive Care Med. 2024 Oct;50(10):1593-1602.
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