Effect of Nutritional Support in Patients with Lower Respiratory Tract Infection: Secondary Analysis of a Randomized Clinical Trial

Overview

Journal Clin Nutr

Publisher Elsevier

Date 2020 Oct 21

PMID 33081983

Citations 11

Authors

Annic Baumgartner

Flavia Hasenboehler

Jennifer Cantone

Lara Hersberger

Annika Bargetzi

Laura Bargetzi

Nina Kaegi-Braun

Pascal Tribolet

Filomena Gomes

Claus Hoess

Vojtech Pavlicek

Stefan Bilz

Sarah Sigrist

Michael Brandle

Christoph Henzen

Robert Thomann

Jonas Rutishauser

Drahomir Aujesky

Nicolas Rodondi

Jacques Donze

Zeno Stanga

Beat Mueller

Philipp Schuetz

Affiliations

Soon will be listed here.

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.

Citing Articles

Practical Guidelines by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) on Nutritional Management of Patients with Chronic Obstructive Pulmonary Disease: A Review.

Justel Enriquez A, Rabat-Restrepo J, Vilchez-Lopez F, Tenorio-Jimenez C, Garcia-Almeida J, Irles Rocamora J Nutrients. 2024; 16(18).

PMID: 39339705 PMC: 11434837. DOI: 10.3390/nu16183105.

Nutritional support in hospitalised patients with diabetes and risk for malnutrition: a secondary analysis of an investigator-initiated, Swiss, randomised controlled multicentre trial.

Keller B, Wunderle C, Tribolet P, Stanga Z, Kaegi-Braun N, Mueller B BMJ Open. 2024; 14(8):e084754.

PMID: 39153787 PMC: 11535698. DOI: 10.1136/bmjopen-2024-084754.

The Possible Role of Food and Diet in the Quality of Life in Patients with COPD-A State-of-the-Art Review.

Fekete M, Csipo T, Fazekas-Pongor V, Balint M, Csizmadia Z, Tarantini S Nutrients. 2023; 15(18).

PMID: 37764686 PMC: 10536642. DOI: 10.3390/nu15183902.

Inflammation and Nutrition: Friend or Foe?.

Stumpf F, Keller B, Gressies C, Schuetz P Nutrients. 2023; 15(5).

PMID: 36904164 PMC: 10005147. DOI: 10.3390/nu15051159.

Subclinical Kwashiorkor in Adults: A New Age Paradigm.

Kapoor N, Bhattacharya S, Agarwal N, Das S, Bantwal G, Deshmukh V Indian J Endocrinol Metab. 2022; 26(3):213-222.

PMID: 36248046 PMC: 9555378. DOI: 10.4103/ijem.ijem_42_22.

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