Different definitions of feeding intolerance and their associations with outcomes of critically ill adults receiving enteral nutrition: a systematic review and meta-analysis

Abstract Background A unified clinical definition of feeding intolerance (FI) is urged for better management of enteral nutrition (EN) in critically ill patients. We aimed to identify optimum clinical FI definitions based on reported evidence. Methods We searched clinical studies comparing FI with non-FI with a clear definition, summarized the evidence by random-effect meta-analyses, and rated the certainty of evidence by the Grading of Recommendations Assessment, Development and Evaluation frameworks. Results Five thousand five hundred twenty-five records were identified, of which 26 eligible studies enrolled 25,189 adult patients. Most patient-centered outcomes were associated with FI overall. Low to very low certainty evidence established FI defined as large gastric residual volume (GRV) ≥ 250 ± 50 mL combined with any other gastrointestinal symptoms (GIS) had a significant association with high mortalities in particular all-cause hospital mortality (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.40–2.57), the incidence of pneumonia (OR 1.54, 95% CI 1.13–2.09) and prolonged length of hospital stay (mean difference 4.20, 95% CI 2.08–6.32), with a moderate hospital prevalence (41.49%, 95% CI 31.61–51.38%). 3-day enteral feeding (EF) delivered percentage < 80% had a moderate hospital prevalence (38.23%, 95% CI 24.88–51.58) but a marginally significant association with all-cause hospital mortality (OR 1.90, 95% CI 1.03–3.50). Conclusions In critically ill adult patients receiving EN, the large-GRV-centered GIS to define FI seemed to be superior to 3-day EF-insufficiency in terms of both close associations with all-cause hospital mortality and acceptable hospital prevalence (Registered PROSPERO: CRD42022326273). Trial registration: The protocol for this review and meta-analysis was registered with PROSPERO: CRD42022326273. Registered 10 May 2022

Data_Sheet_1_Genetic associations between autoimmune diseases and the risks of severe sepsis and 28-day mortality: a two-sample Mendelian randomization study.zip

BackgroundAutoimmune diseases exhibit heterogenous dysregulation of pro-inflammatory or anti-inflammatory cytokine expression, akin to the pathophysiology of sepsis. It is speculated that individuals with autoimmune diseases may have an increased likelihood of developing sepsis and face elevated mortality risks following septic events. However, current observational studies have not yielded consistent conclusions. This study aims to explore the causal relationship between autoimmune diseases and the risks of sepsis and mortality using Mendelian randomization (MR) analysis.MethodsWe conducted a two-sample MR study involving a European population, with 30 autoimmune diseases as the exposure factors. To assess causal relationships, we employed the inverse variance-weighted (IVW) method and used Cochran's Q test for heterogeneity, as well as the MR pleiotropy residual sum and outlier (MR-PRESSO) global test for potential horizontal pleiotropy.ResultsGenetically predicted Crohn's disease (β = 0.067, se = 0.034, p = 0.046, OR = 1.069, 95% CI = 1.001–1.141) and idiopathic thrombocytopenic (β = 0.069, se = 0.031, p = 0.023, OR = 1.071, 95% CI = 1.009–1.136) were positively associated with an increased risk of sepsis in critical care. Conversely, rheumatoid arthritis (β = −0.104, se = 0.047, p = 0.025, OR = 0.901, 95% CI = 0.823–0.987), ulcerative colitis (β = −0.208, se = 0.084, p = 0.013, OR = 0.812, 95% CI = 0.690–0.957), and narcolepsy (β = −0.202, se = 0.092, p = 0.028, OR = 0.818, 95% CI = 0.684–0.978) were associated with a reduced risk of sepsis in critical care. Moreover, Crohn's disease (β = 0.234, se = 0.067, p = 0.001, OR = 1.263, 95% CI = 1.108–1.440) and idiopathic thrombocytopenic (β = 0.158, se = 0.061, p = 0.009, OR = 1.171, 95% CI = 1.041–1.317) were also linked to an increased risk of 28-day mortality of sepsis in critical care. In contrast, multiple sclerosis (β = −0.261, se = 0.112, p = 0.020, OR = 0.771, 95% CI = 0.619–0.960) and narcolepsy (β = −0.536, se = 0.184, p = 0.003, OR = 0.585, 95% CI = 0.408–0.838) were linked to a decreased risk of 28-day mortality of sepsis in critical care.ConclusionThis MR study identified causal associations between certain autoimmune diseases and risks of sepsis in critical care, and 28-day mortality in the European population. These findings suggest that exploring the mechanisms underlying autoimmune diseases may offer new diagnostic and therapeutic strategies for sepsis prevention and treatment.</p

Poor lung ultrasound score in shock patients admitted to the ICU is associated with worse outcome

Abstract Background The lung ultrasound score has been regarded as a decent semiquantitative score to measure the lung aeration loss. The score has been proven to be valuable in diagnosing and monitoring lung pathology, but no studies have demonstrated its relationship to the outcome. We aimed to investigate the relationship between the lung ultrasound score and outcome in shock patients in the Intensive Care Unit. Methods The data were extracted from the SHOCK-ICU study, a 14-month prospective study of shock patients in the Medical Intensive Care Unit in West China Hospital. A bivariate logistic regression model was established to identify the correlation between the lung ultrasound score on admission and the 28-day mortality. For subsequent analyses, we divided patients into lung ultrasound score quartiles, and survival analysis was performed using Cox stratified survival analysis and regression analysis with the Breslow method of ties. Results A total of 175 cases with a completed lung ultrasound exam were included. The mean APACHE II score was 23.7 ± 8.8, and the 28-day mortality was 46.3% (81/175). The multivariate analysis demonstrated that the lung ultrasound score was an independent risk factor for 28-day mortality, as well as the APACHE II score and lactate level. When divided into lung ultrasound score quartiles, after correcting for the APACHE II score, vasoactive use, PaO2/FiO2, and lactate level, the COX analysis reveals that a higher lung ultrasound score was related to a lower survival rate. Quartile 1 and quartile 2 had a significantly lower hazard ratio versus quartile 4 (OR 0.442[0.215–0.911]; 0.484[0.251–0.934], respectively). Conclusions The lung ultrasound score is independently related to the 28-day mortality, as well as the APACHE II score and lactate level, in Intensive Care Unit shock patients. A higher elevated lung ultrasound score on admission is associated with a worse outcome. Trial registration The study is registered on Clinical Trials. Trial registration: NCT03082326; retrospectively registered on 3 March 2017

The utilization of critical care ultrasound to assess hemodynamics and lung pathology on ICU admission and the potential for predicting outcome

<div><p>Aim</p><p>Critical care ultrasound (CCUS) has been used by many Intensive Care Units(ICUs) worldwide, so as to guiding the diagnosis and the treatment. However, none of the publications currently systematically describe the utilization of CCUS to analyze the characteristics of hemodynamics and lung pathology upon the new admission to ICU and its potential role in patients’ prognosis prediction. In this retrospective clinical study, we have demonstrated and analyzed the characteristics of hemodynamics and lung pathology assessed by CCUS and investigated its potential to predict patient outcome.</p><p>Methods</p><p>We have described and analyzed the epidemic characteristics of hemodynamics and lung pathology assessed by CCUS on ICU admission, which based on our database of 451 cases from the biggest medical center in Western China, between November 2014 and October 2015. The patients’ demographics, clinical characteristics, prognosis and ultrasonic pattern of hemodynamics and lung pathology had been analyzed. A bivariate logistic regression model was established to identify the correlation between the ultrasonic variables on admission and the ICU mortality.</p><p>Results</p><p>The mean age of the 451 patients was 56.7±18.7 years; the mean APACHE II score was 19.0±7.9, the ICU mortality was 30.6%. Patients received CCUS examination of pericardial, right ventricle (RV) wall motion, left ventricle (LV) wall motion, LV systolic function, LV diastolic function, lung and volume of inferior vena cava (IVC) were 423(93.8%), 418(92.7%), 392(86.9%), 389(86.3%), 383(84.9%), 440(97.6%), 336(74.5%), respectively; The univariate analysis revealed that length of mechanical ventilation was significantly correlated with the diameter of IVC, tricuspid annular plane systolic excursion(TAPSE), mitral annular plane systolic excursion(MAPSE), early diastolic transmitral velocity to early mitral annulus diastolic velocity(E/e’) (p = 0.016, 0.011, 0.000, 0.049, respectively); The TAPSE, ejection fraction(EF), MAPSE, lung ultrasound score (LUS score) (p = 0.000, 0.028, 0.000, 0.011, respectively) were significantly related to ICU mortality. The multivariate analysis demonstrated that APACHE II, age, TAPSE, E/e’ are the independent risk factors for ICU mortality in our study.</p><p>Conclusion</p><p>CCUS examination on ICU admission which performed by the experienced physician provide valuable information to assist the caregivers in understanding the comprehensive outlook of the characteristics of hemodynamics and lung pathology. Those key variables obtained by CCUS predict the possible prognosis of patients, hence deserve more attention in clinical decision making.</p></div

Preliminary Exploration of Epidemiologic and Hemodynamic Characteristics of Restrictive Filling Diastolic Dysfunction Based on Echocardiography in Critically Ill Patients: A Retrospective Study

Objective. To preliminarily describe the epidemiologic and hemodynamic characteristics of critically ill patients with restrictive filling diastolic dysfunction based on echocardiography. Setting. A retrospective study. Methods. Epidemiologic characteristics of patients with restrictive filling diastolic dysfunction in ICU were described; clinical and hemodynamic data were preliminarily summarized and compared between patients with and without restrictive filling diastolic dysfunction; most of the data were based on echocardiography. Results. More than half of the patients in ICU had diastolic dysfunction and about 16% of them had restrictive filling pattern. The patients who had restrictive filling diastolic dysfunction were more likely to have wider diameter of IVC (2.18±0.50 versus 1.92±0.43, P=0.037), higher extravascular lung water score (15.9±9.2 versus 13.2±9.1, P=0.014), lower left ventricular ejection fraction (EF-S: 53.0±16.3 versus 59.3±12.5, P=0.014), and lower percentage of normal LAP that was estimated by E/e′ (8.9% versus 90.0%, P=0.001) when compared with those of patients without restrictive filling diastolic dysfunction. Conclusion. Our results suggest that critically ill patients with restrictive filling diastolic dysfunction may experience rising volume status, increasing extravascular lung water ultrasonic score, reducing long-axis systolic dysfunction, and less possibility of normal left atrial pressure. Intensivists are advised to pay more attention to patients with diastolic dysfunction, especially the exquisite fluid management of patients with restrictive filling pattern due to the close relationship of restrictive filling diastolic dysfunction with volume status and extravascular lung water in our study

Completion proportion and findings of ultrasound examination on admission.

<p>Completion proportion and findings of ultrasound examination on admission.</p

Multivariate analysis between the cardiorespiratory ultrasonic variables and clinical indexes and ICU mortality.

<p>Multivariate analysis between the cardiorespiratory ultrasonic variables and clinical indexes and ICU mortality.</p

Univariate correlation analysis: Correlation coefficients (r) and p values.

<p>Univariate correlation analysis: Correlation coefficients (r) and p values.</p

Admission diagnoses and the proportion.

<p>Admission diagnoses and the proportion.</p