Clinical outcomes of burned patients receiving early enteral immunonutrition: A retrospective analysis

<h2>Summary</h2><h3>Background & aims</h3> Burn patients are characterised by profound oxidative stress, intense inflammation, and prolonged hypermetabolic and catabolic states proportional to injury severity. Immunonutrition, incorporating substrates such as arginine, omega-3 fatty acids, and ribonucleotides, has shown advantages in regulating immune responses and minimizing complications across various patient populations, providing the rationale for its application in severely burned patients. This study compared outcomes between early enteral immunonutrition (iEN) and standard enteral or parenteral nutrition. <h3>Methods</h3> A retrospective observational study was carried out on 114 adult patients with severe burns (age >18 years, total body surface area [BSA] >20%). Patients were divided into an iEN group (n=51; initiation within 48 hours of admission) and a control group (n=63). Baseline characteristics were compared between groups, including prognostic severity, using the Baux index. Overall in-hospital mortality was the primary outcome, while secondary outcomes included the duration of hospital stay, onset of sepsis, and mortality rate stratified by the Baux index. <h3>Results</h3> The average age of the included patients was 61.2 ± 21 years in the iEN group, compared to 61.7 ± 18 years in the control group. The iEN group had a higher baseline severity (mean Baux index 120 ± 30.5 vs. 110 ± 34 in the control group). Patients receiving iEN demonstrated a lower overall mortality rate (49% vs. 55.6% in the control group) and a delayed onset of sepsis (mean 9.2 ± 7.1 days vs. 4.9 ± 3.7 days). Among patients with a Baux index >100, the mortality rate was reduced in the iEN group (64.1% vs. 77.5% in controls). <h3>Conclusions</h3> iEN appears to improve survival and delay sepsis onset in patients with severe burns, particularly in those with higher baseline severity. These findings highlight the potential of iEN to modulate immune responses and improve clinical outcomes in this population. Further research is warranted to confirm our findings.