title: Near-target caloric intake in critically ill medical-surgical patients is associated with adverse outcomes.
abstract: BACKGROUND
  The objective of this study was to determine whether caloric intake independently influences mortality and morbidity of critically ill patients.
  
  
  METHODS
  The study was conducted as a nested cohort study within a randomized controlled trial in a tertiary care intensive care unit (ICU). The main exposure in the study was average caloric intake/target for the first 7 ICU days. The primary outcomes were ICU and hospital mortality. Secondary outcomes included ICU-acquired infections, ventilator-associated pneumonia (VAP), duration of mechanical ventilation days, and ICU and hospital length of stay (LOS). The authors divided patients (n = 523) into 3 tertiles according to the percentage of caloric intake/target: tertile I <33.4%, tertile II 33.4%-64.6%, and tertile III >64.6%. To adjust for potentially confounding variables, the authors assessed the association between caloric intake/target and the different outcomes using multivariate logistic regression for categorical outcomes (tertile I was used as reference) and multiple linear regression for continuous outcomes.
  
  
  RESULTS
  Tertile III was associated with higher adjusted hospital mortality, higher risk of ICU-acquired infections, and a trend toward higher VAP rate. Increasing caloric intake was independently associated with a significant increase in duration of mechanical ventilation, ICU LOS, and hospital LOS.
  
  
  CONCLUSIONS
  The data demonstrate that near-target caloric intake is associated with significantly increased hospital mortality, ICU-acquired infections, mechanical ventilation duration, and ICU and hospital LOS. Further studies are needed to explore whether reducing caloric intake would improve the outcomes in critically ill patients.
authors.affiliation: Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia. yaseenarabi@yahoo.com
authors.forename: Yaseen M
authors.initials: YM
authors.lastname: Arabi
authors.forename: Samir H
authors.initials: SH
authors.lastname: Haddad
authors.forename: Hani M
authors.initials: HM
authors.lastname: Tamim
authors.forename: Asgar H
authors.initials: AH
authors.lastname: Rishu
authors.forename: Maram H
authors.initials: MH
authors.lastname: Sakkijha
authors.forename: Salim H
authors.initials: SH
authors.lastname: Kahoul
authors.forename: Riette J
authors.initials: RJ
authors.lastname: Britts
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods / Q000592:standards*; D016638:Critical Illness / Q000401:mortality*; D003428:Cross Infection / Q000209:etiology*; D002149:Energy Intake; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology; D011182:Postoperative Care / Q000379:methods / Q000592:standards*; D012016:Reference Values; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012307:Risk Factors