Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study
Authors: Pardo Emmanuel , Lescot Thomas , Preiser Jean-Charles , Massanet Pablo , Pons Antoine , Jaber Samir , Fraipont Vincent , Levesque Eric , Ichai Carole , Petit Laurent , Tamion Fabienne , Taverny Garry , Boizeau Priscilla , Alberti Corinne , Constantin Jean-Michel , Bonnet Marie-Pierre ,   the FRANS study group, Samba Désiré , Moyer Jean-Denis , Montravers Philippe , Mongardon Nicolas , Meffert Arnaud , De Jong Audrey , Belafia Fouad , Morel Jérome , Asehnoune Karim , Mahé Pierre-Joachim , D’Hondt Alain , Paquot Nicolas , Leone Marc , Kaidomar Michel , Grech Ludovic , Gouteix Eliane , Barsam Elise , Duranteau Jacques , Martinez Orianne 
Published: January 2023

Abstract
Background
Current guidelines suggest the introduction of early nutrition support within the first 48 h of admission to the intensive care unit (ICU) for patients who cannot eat. In that context, we aimed to describe nutrition practices in the ICU and study the association between the introduction of early nutrition support (< 48 h) in the ICU and patient mortality at day 28 (D28) using data from a multicentre prospective cohort.

Methods
The ‘French-Speaking ICU Nutritional Survey’ (FRANS) study was conducted in 26 ICUs in France and Belgium over 3 months in 2015. Adult patients with a predicted ICU length of stay > 3 days were consecutively included and followed for 10 days. Their mortality was assessed at D28. We investigated the association between early nutrition (< 48 h) and mortality at D28 using univariate and multivariate propensity-score-weighted logistic regression analyses.

Results
During the study period, 1206 patients were included. Early nutrition support was administered to 718 patients (59.5%), with 504 patients receiving enteral nutrition and 214 parenteral nutrition. Early nutrition was more frequently prescribed in the presence of multiple organ failure and less frequently in overweight and obese patients. Early nutrition was significantly associated with D28 mortality in the univariate analysis (crude odds ratio (OR) 1.69, 95% confidence interval (CI) 1.23–2.34) and propensity-weighted multivariate analysis (adjusted OR (aOR) 1.05, 95% CI 1.00–1.10). In subgroup analyses, this association was stronger in patients ≤ 65 years and with SOFA scores ≤ 8. Compared with no early nutrition, a significant association was found of D28 mortality with early enteral (aOR 1.06, 95% CI 1.01–1.11) but not early parenteral nutrition (aOR 1.04, 95% CI 0.98–1.11).

Conclusions
In this prospective cohort study, early nutrition support in the ICU was significantly associated with increased mortality at D28, particularly in younger patients with less severe disease. Compared to no early nutrition, only early enteral nutrition appeared to be associated with increased mortality. Such findings are in contrast with current guidelines on the provision of early nutrition support in the ICU and may challenge our current practices, particularly concerning patients at low nutrition risk.
Trial registration ClinicalTrials.gov Identifier: NCT02599948. Retrospectively registered on November 5th 2015.