Association Between Nutritional Status, Energy-Protein-Micronutrient Intake, and Mortality in Critically Ill Patients Receiving Enteral Nutrition

Aim: Malnutrition is a common issue in the intensive care units (ICUs) and can lead to poor clinical outcomes if not managed with adequate nutritional support.This study aimed to examine the association between energy, protein, and micronutrient intake and mortality among malnourished and well-nourished critically ill patients.Study Design: This retrospective cohort study was conducted in a tertiary medical ICU.Patients were enrolled within the first 48 hours of ICU admission and categorized as either wellnourished (modified Nutrition Risk in the Critically Ill [mNUTRIC] score: 0-4) or malnourished (mNUTRIC score: 5-9).Daily energy, protein, and micronutrient intake of adult critically ill patients receiving enteral tube feeding was meticulously monitored during the first seven days in the ICU.Results: A total of 226 patients were included, with 137 classified as malnourished and 89 as well-nourished.The median age of the study population was 65.0 years (range: 47.8-74.0).Patients with malnutrition had lower energy adequacy (%) compared to well-nourished patients (median: 52.3 vs. 68.3,p=0.001).Malnourished patients also received significantly lower amounts of chromium, copper, iodine, iron, manganese, molybdenum, selenium, biotin, vitamin A, vitamin C, and vitamin D compared to well-nourished patients (p<0.05 for all).Multivariate Cox regression analysis revealed that the mNUTRIC score was a significant predictor of ICU mortality (Hazard Ratio (95% Confidence Interval): 1.235 (1.112-1.371),p<0.001).Kaplan-Meier analysis demonstrated that malnourished patients had a significantly lower probability of survival compared to well-nourished patients (median (95% CI): 29.0 (16.2-41.8) vs. 17.0 (15.0-19.0)days, p=0.001). Conclusions:Critically ill adult patients with malnutrition had significantly lower energy and selected micronutrient intake via the enteral route, along with a reduced probability of survival.