Effect of nutritional support in patients with lower respiratory tract infection: Secondary analysis of a randomized clinical trial.

Baumgartner, Annic; Hasenboehler, Flavia; Cantone, Jennifer; Hersberger, Lara; Bargetzi, Annika; Bargetzi, Laura; Kaegi-Braun, Nina; Tribolet, Pascal; Gomes, Filomena; Hoess, Claus; Pavlicek, Vojtech; Bilz, Stefan; Sigrist, Sarah; Brändle, Michael; Henzen, Christoph; Thomann, Robert; Rutishauser, Jonas; Aujesky, Drahomir; Rodondi, Nicolas; Donzé, Jacques; ... (2021). Effect of nutritional support in patients with lower respiratory tract infection: Secondary analysis of a randomized clinical trial. Clinical nutrition, 40(4), pp. 1843-1850. Elsevier 10.1016/j.clnu.2020.10.009

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BACKGROUND

In polymorbid patients with bronchopulmonary infection, malnutrition is an independent risk factor for mortality. There is a lack of interventional data investigating whether providing nutritional support during the hospital stay in patients at risk for malnutrition presenting with lower respiratory tract infection lowers mortality.

METHODS

For this secondary analysis of a randomized clinical trial (EFFORT), we analyzed data of a subgroup of patients with confirmed lower respiratory tract infection from an initial cohort of 2028 patients. Patients at nutritional risk (Nutritional Risk Screening [NRS] score ≥3 points) were randomized to receive protocol-guided individualized nutritional support to reach protein and energy goals (intervention group) or standard hospital food (control group). The primary endpoint of this analysis was all-cause 30-day mortality.

RESULTS

We included 378 of 2028 EFFORT patients (mean age 74.4 years, 24% with COPD) into this analysis. Compared to usual care hospital nutrition, individualized nutritional support to reach caloric and protein goals showed a similar beneficial effect of on the risk of mortality in the subgroup of respiratory tract infection patients as compared to the main EFFORT trial (odds ratio 0.47 [95%CI 0.17 to 1.27, p = 0.136] vs 0.65 [95%CI 0.47 to 0.91, p = 0.011]) with no evidence of a subgroup effect (p for interaction 0.859). Effects were also similar among different subgroups based on etiology and type of respiratory tract infection and for other secondary endpoints.

CONCLUSION

This subgroup analysis from a large nutrition support trial suggests that patients at nutritional risk as assessed by NRS 2002 presenting with bronchopulmonary infection to the hospital likely have a mortality benefit from individualized inhospital nutritional support. The small sample size and limited statistical power calls for larger nutritional studies focusing on this highly vulnerable patient population.

CLINICAL TRIAL REGISTRATION

Registered under ClinicalTrials.gov Identifier no. NCT02517476.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Endocrinology, Diabetology and Clinical Nutrition
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Aujesky, Drahomir; Rodondi, Nicolas; Donzé, Jacques and Stanga-Nodari, Zeno

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0261-5614

Publisher:

Elsevier

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

22 Oct 2020 11:30

Last Modified:

29 Apr 2021 04:37

Publisher DOI:

10.1016/j.clnu.2020.10.009

PubMed ID:

33081983

Uncontrolled Keywords:

COVID19 Malnutrition Nutritional support Outcome Randomized trial Respiratory infection

BORIS DOI:

10.7892/boris.147241

URI:

https://boris.unibe.ch/id/eprint/147241

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