Impact of early nutrition and feeding route on clinical outcomes of neurocrically ill patients

Background: To investigate whether early nutrition is associated with clinical outcomes of neurocritically ill patients. Methods: Among neurosurgical patients admitted to the intensive care unit (ICU) in a tertiary hospital from January 2013 to December 2019, patients who were hospitalized in the ICU for more than 5 days were included. Patients who started enteral nutrition or parenteral nutrition within 72 hours after ICU admission were defined as the early nutrition group. The primary endpoint was in-hospital mortality. Secondary endpoint was infectious complication. Propensity score matching (PSM) and propensity score weighting (PSW) were used to control selection bias and confounding factors. PSW was performed using target weights (PSTW), inverse probability of treatment weights (IPTW), and overlap weights (PSOW). Results: Among total of 1,353 patients, early nutrition was performed in 384 (28.4%) patients. Early enteral nutrition (EEN) was performed in 152 (11.2%) patients and early parenteral nutrition (EPN) in 232 (17.1%) patients. In the overall study population, the rate of in-hospital mortality was higher in patients with late nutrition than in those with early nutrition (p < 0.001). Rates of in-hospital mortality and infectious complications were higher in patients with non-EEN than in those with EEN (p < 0.001 and p = 0.004, respectively). Although early nutrition seemed to be associated with clinical outcomes of neurocritically ill patients in univariable analysis, the number of patients with EEN or EPN was small and severity levels were different between nutrition groups. In multivariable analysis of the overall population, PSM adjusted population, and PSW adjusted population, early nutrition was not significantly associated with in-hospital mortality and infectious complications (all p > 0.05) except for in-hospital mortality of the PSTW population. However, EEN was significantly associated with in-hospital mortality and infectious complications (all p < 0.05) except for in-hospital mortality of the IPTW population. Conclusions: In this study, early nutrition was not significantly associated with clinical outcomes. However, EEN was significantly associated with in-hospital mortality and infectious complications. Thus, EEN might be superior to EPN for reducing mortality and improving outcomes of neurocritically ill patients.