Impact of Early Enteral Nutrition on In-Hospital Mortality in Patients with Hypertensive Intracerebral Hemorrhage

Abstract

Objective : We conducted this study to evaluate the clinical impact of early enteral nutrition (EN) on in-hospital mortality and outcome in patients with critical hypertensive intracerebral hemorrhage (ICH). Methods : We retrospectively analyzed 123 ICH patients with Glasgow Coma Scale (GCS) score of 3-12. We divided the subjects into two groups : early EN group (< 48 hours, n = 89) and delayed EN group (≥ 48 hours, n = 34). Body weight, total intake and output, serum albumin, Creactive protein, infectious complications, morbidity at discharge and in-hospital mortality were compared with statistical analysis. Results : The incidence of nosocomial pneumonia and length of intensive care unit stay were significantly lower in the early EN group than in the delayed EN group (p < 0.05). In-hospital mortality was less in the early EN group than in the delayed EN group (10.1% vs. 35.3%, respectively; p = 0.001). By multivariate analysis, early EN [odds ratio (OR) 0.229, 95% CI : 0.066-0.793], nosocomial pneumonia (OR = 5.381, 95% CI : 1.621-17.865) and initial GCS score (OR = 1.482 95% CI : 1.160-1.893) were independent predictors of in-hospital mortality in patients with critical hypertensive ICH. Conclusion : These findings indicate that early EN is an important predictor of outcome in patients with critical hypertensive ICH.

Factors Associated with Severity on Admission and In-Hospital Mortality after Primary Intracerebral Hemorrhage in China

“…In logistic regression analysis, after adjusting for potential confounders, we also found that GCS score was independently associated with severity on admission and in‐hospital mortality after PICH, whereby the lower GCS score on admission, the worse severity on admission and greater in‐hospital mortality. These findings correspond with results from many previous studies in which the initial consciousness level evaluated by GCS score was the most important and consistent predictor of ICH outcome and mortality .…”

Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines

“…A large RCT compared EEN (“as soon as possible”) to no nutrition within 7 days and reported a trend towards reduction of long-term mortality (6 months) with EN, with an increased risk of poor neurologic outcome in survivors [ 30 ]. An observational study reported reduction in infectious complications with EEN vs. delayed EN [ 31 ].…”

Medical management of intracerebral haemorrhage

“…Early (enteral) feeding (ie, within 48 hours) should be considered in ICH patients as it is associated with reduced risk of pneumonia and improved survival 23. High blood glucose in the acute phase of ICH shows a continuous relation with early deterioration, poor functional outcome and higher mortality regardless of diabetic status 24.…”