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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; Stanga, Zeno; Mueller, Beat; Schuetz, Philipp.
  • Baumgartner A; Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
  • Hasenboehler F; Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
  • Cantone J; Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
  • Hersberger L; Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
  • Bargetzi A; Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
  • Bargetzi L; Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
  • Kaegi-Braun N; Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
  • Tribolet P; Internal Medicine, Spital Lachen, Switzerland; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
  • Gomes F; Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; The New York Academy of Sciences, New York City, NY, USA.
  • Hoess C; Internal Medicine, Kantonsspital Muensterlingen, Switzerland.
  • Pavlicek V; Internal Medicine, Kantonsspital Muensterlingen, Switzerland.
  • Bilz S; Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland.
  • Sigrist S; Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland.
  • Brändle M; Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland.
  • Henzen C; Internal Medicine, Kantonsspital Luzern, Switzerland.
  • Thomann R; Department of Internal Medicine, Buergerspital Solothurn, Switzerland.
  • Rutishauser J; Internal Medicine, Kantonsspital Baselland, Switzerland.
  • Aujesky D; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
  • Rodondi N; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.
  • Donzé J; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland.
  • Stanga Z; Division of Diabetology, Endocrinology, Nutritional Medicine & Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland.
  • Mueller B; Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
  • Schuetz P; Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland. Electronic address: schuetzph@gmail.com.
Clin Nutr ; 40(4): 1843-1850, 2021 04.
Article in English | MEDLINE | ID: covidwho-882503
ABSTRACT

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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Tract Infections / Nutritional Support / Malnutrition Type of study: Cohort study / Etiology study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Clin Nutr Year: 2021 Document Type: Article Affiliation country: J.clnu.2020.10.009

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Tract Infections / Nutritional Support / Malnutrition Type of study: Cohort study / Etiology study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Clin Nutr Year: 2021 Document Type: Article Affiliation country: J.clnu.2020.10.009