Early Enteral Nutrition Adequacy Mitigates the Neutrophil–Lymphocyte Ratio Improving Clinical Outcomes in Critically Ill Surgical Patients

Luis Alfonso Ortiz-Reyes, Yuchiao Chang, Sadeq A. Quraishi, Liyang Yu, Haytham Kaafarani, Marc de Moya, David R. King, Peter Fagenholz, George Velmahos, Daniel Dante Yeh

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: Neutrophil–lymphocyte ratio (NLR) is a measure of host inflammatory response; a higher NLR is associated with worse clinical outcomes. Enteral nutrition (EN) may mitigate inflammation through interaction with gut-associated lymphoid tissue. We hypothesized that early EN adequacy in critically ill surgical patients is associated with lower NLR and better clinical outcomes. Methods: In this retrospective study, we analyzed data from adult surgical intensive care unit (ICU) patients receiving EN. NLR at baseline ICU admission (NLR-B), NLR after 3–5 days of EN (F-NLR), nutrition adequacy, caloric deficit (CD), protein deficit (PD), hospital length of stay (LOS), ICU LOS, 28-day ventilator-free days (28-VFD), and in-hospital mortality were collected. Tertiles groups were created for NLR, F-NLR, CD, and PD; the highest (H) and lowest (L) tertiles were compared. Regression analyses were performed to control for effect of age, gender, APACHE II, and NLR. Results: Subjects in the L-CD group had lower median F-NLR (7 [range, 5–11] vs 10 [7–22], P = 0.005) and shorter ICU LOS (9 [6–16]) vs 16 [9–32] days; P = 0.006). The L-NLR group had shorter hospital LOS (18 [10–31] vs 22 [15–38] days, P = 0.023), greater 28-VFD (23 [18–25] vs 19 [11–22] days, P = 0.005), and lower in-hospital mortality (13% vs 41%, P = 0.002). Conclusion: In critically ill surgical patients, early enteral caloric adequacy is associated with less inflammation and improved clinical outcomes.

Original languageEnglish (US)
Pages (from-to)148-155
Number of pages8
JournalNutrition in Clinical Practice
Volume34
Issue number1
DOIs
StatePublished - Feb 2019

Keywords

  • critical illness
  • enteral nutrition
  • inflammation
  • intensive care unit
  • lymphocytes
  • neutrophils
  • surgery

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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