The impact of timing of enteral nutrition initiation on the prognosis of abdominal infection in critically ill patients

This single-center retrospective study investigates the effect of the timing of enteral nutrition (EN) initiation on the prognosis of critically ill patients with abdominal infection and provide evidence for clinical nutrition support strategies. A total of 76 patients with abdominal infections who were admitted to the intensive care unit (ICU) of our hospital from January 2023 to December 2024 were included. The patients were divided into 2 groups based on the timing of EN initiation: the early EN group (≤48 hours, n = 42) and the delayed EN group (>48 hours, n = 34). Data on demographic characteristics, disease severity scores, infection types, nutritional intake, EN-related complications, and clinical outcomes were collected. The differences in 28-day mortality, ICU length of stay, infection control time, and nutritional adequacy between the 2 groups were compared. A logistic regression model was used to analyze the independent effect of EN initiation timing on 28-day mortality, and subgroup analysis was performed to explore the prognostic effect of EN initiation timing in different clinical contexts. There were no statistically significant differences in the baseline characteristics between the 2 groups, making them comparable. Compared to the delayed EN group, the early EN group had a lower 28-day mortality (19.0% vs 35.3%, P = .048), shorter ICU length of stay (10.8 ± 4.2 vs 13.6 ± 5.1 days, P = .011), shorter infection control time (4.8 ± 1.5 vs 6.3 ± 2.1 days, P = .002), and faster C-reactive protein recovery (5.6 ± 1.9 vs 7.4 ± 2.2 days, P = .001), with more adequate and faster nutritional intake. Logistic regression analysis showed that delayed EN initiation was an independent risk factor for 28-day mortality (odds ratios = 2.51, 95% confidence interval: 1.09-5.82, P = .030). Subgroup analysis suggested that early EN provided a more significant survival benefit in patients with an APACHE II score ≥ 20 or those requiring mechanical ventilation (interaction P values of .041 and .049, respectively). For critically ill patients with abdominal infections, early initiation of EN helps improve nutritional status, accelerate infection control, and reduce 28-day mortality, especially in patients with more severe conditions or those requiring mechanical ventilation, where the prognosis is improved more significantly. The timing of EN initiation should be emphasized in critical care nutrition support.