Standard-polymer formula versus short-peptide formula for sepsis patients with acute gastrointestinal injury -- a retrospective cohort study

Abstract

Background To investigate the selection of enteral nutrition (EN) formulas for critically ill sepsis patients with acute gastrointestinal injury (AGI) grade I-II. Methods We conducted a retrospective cohort study on critically ill sepsis patients with AGI grades I-II. The primary outcomes were EN caloric adequacy on day 7, calories and protein growth from EN within 3–7 days, and the incidence of gastric retention and diarrhea after EN administration. We performed a subgroup analysis based on whether patients initiated EN within 48 hours. Results In the early EN subgroup, caloric adequacy, calories and protein growth of EN on day 7 of the short-peptide group was higher than that of the standard-polymeric group (59.1% vs. 27.3%, p = 0.001; 624[0,936] vs. 0[-360,480], p = 0.001; 24[0,38] vs. 0[-14.4,19.2], p = 0.003, respectively), and the incidence of gastric retention (18.2% vs. 36.4%, p = 0.03) and diarrhea (9.1% vs. 25.5%, p = 0.02) were lower in the short-peptide group than in the standard-polymeric group. However, in the delayed EN subgroup, the caloric adequacy of EN on day 7 of the short-peptide group was lower than that of the standard-polymeric group (28.6% vs. 43.5%, p = 0.02), calories and protein growth from EN were lower in the short-peptide group than in the standard-polymeric group (960[480,1200] vs. 1080[720,1440], p = 0.04; 38.4[19.2,50.4] vs. 43.2[28.8,57.6], p = 0.04, respectively). Conclusion For sepsis patients with AGI grade I-II, it is recommended to choose short-peptide formulas for those who initiate EN early (≤ 48h), while standard-polymer formulas are recommended for those who initiate EN late (> 48h).