title: Clinical Outcomes in Critically Ill Patients Associated With the Use of Complex vs Weight-Only Predictive Energy Equations.
abstract: BACKGROUND
  The energy intake goal is important to achieving energy intake in critically ill patients, yet clinical outcomes associated with energy goals have not been reported.
  
  
  METHODS
  This secondary analysis used the Improving Nutrition Practices in the Critically III International Nutrition Surveys database from 2007-2009 to evaluate whether mortality or time to discharge alive is related to use of complex energy prediction equations vs weight only. The sample size was 5672 patients in the intensive care unit (ICU) ≥ 4 days and a subset of 3356 in the ICU ≥ 12 days. Mortality and time to discharge alive were compared between groups by regression, controlling for age, sex, admission type, Acute Physiology and Chronic Health Evaluation II score, ICU geographic region, actual energy intake, and obesity.
  
  
  RESULTS
  There was no difference in mortality between the use of complex and weight-only equations (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.86-1.15), but obesity (OR, 0.83; 95% CI, 0.71-0.96) and higher energy intake (OR, 0.65; 95% CI, 0.56-0.76) had lower odds of mortality. Time to discharge alive was shorter in patients fed using weight-only equations (hazard ratio [HR], 1.11; 95% CI, 1.01-1.23) in patients staying ≥ 4 days and with greater energy intake (HR, 1.19; 95% CI, 1.06-1.34) in patients in the ICU ≥ 12 days.
  
  
  CONCLUSIONS
  These data suggest that higher energy intake is important to survival and time to discharge alive. However, the analysis was limited by actual energy intake <70% of goal. Delivery of full goal intake will be needed to determine the relationship between the method of determining energy goal and clinical outcomes.
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania compherc@nursing.upenn.edu.
authors.forename: Charlene
authors.initials: C
authors.lastname: Compher
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Michele
authors.initials: M
authors.lastname: Nicolo
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
authors.forename: Jesse
authors.initials: J
authors.lastname: Chittams
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
authors.forename: Youjeong
authors.initials: Y
authors.lastname: Kang
authors.affiliation: Clinical Evaluation Research Unit, Kingston General Hospital, Ontario, Canada.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Day
authors.affiliation: Clinical Evaluation Research Unit, Kingston General Hospital, Ontario, Canada.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D015992:Body Mass Index; D001835:Body Weight; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D003430:Cross-Sectional Studies; D002149:Energy Intake; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D010351:Patient Discharge; D016896:Treatment Outcome
keywords: ICU; energy; length of stay; mortality; predictive equation