{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:54:52Z","timestamp":1789055692009,"version":"build-2803163510"},"reference-count":29,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T00:00:00Z","timestamp":1653955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>The initial nutritional delivery policy for patients with sepsis admitted to the intensive care unit (ICU) has not been fully elucidated. We aimed to determine whether an initial adequate nutrition supply and route of nutrition delivery during the first week of sepsis onset improve clinical outcomes of critically ill patients with sepsis. We reviewed adult patients with sepsis and septic shock in the ICU in a single tertiary teaching hospital between 31 November 2013 and 20 May 2017. Poisson log-linear and Cox regressions were performed to assess the relationships between clinical outcomes and sex, modified nutrition risk in the critically ill score, sequential organ failure assessment score, route of nutrition delivery, acute physiology and chronic health evaluation score, and daily energy and protein delivery during the first week of sepsis onset. In total, 834 patients were included. Patients who had a higher protein intake during the first week of sepsis onset had a lower in-hospital mortality (adjusted hazard ratio (HR), 0.55; 95% confidence interval (CI), 0.39\u20130.78; p = 0.001). A higher energy intake was associated with a lower 30-day mortality (adjusted HR, 0.94; 95% CI, 0.90\u20130.98; p = 0.003). The route of nutrition delivery was not associated with 1-year mortality in the group which was underfed; however, in patients who met &gt; 70% of their nutritional requirement, enteral feeding (EN) with supplemental parenteral nutrition (PN) was superior to only EN (p = 0.016) or PN (p = 0.042). In patients with sepsis and septic shock, a high daily average protein intake may lower in-hospital mortality, and a high energy intake may lower the 30-day mortality, especially in those with a high modified nutrition risk in the critically ill scores. In patients who receive adequate energy, EN with supplemental PN may be better than only EN or PN, but not in underfed patients.<\/jats:p>","DOI":"10.3390\/nu14112318","type":"journal-article","created":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T03:33:18Z","timestamp":1654054398000},"page":"2318","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Effect of Early Nutritional Support on Clinical Outcomes of Critically Ill Patients with Sepsis and Septic Shock: A Single-Center Retrospective Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Jun-Kwon","family":"Cha","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6385-9619","authenticated-orcid":false,"given":"Hyung-Sook","family":"Kim","sequence":"additional","affiliation":[{"name":"Inter-Department of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea"},{"name":"Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun-Ji","family":"Kim","sequence":"additional","affiliation":[{"name":"Inter-Department of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea"},{"name":"Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun-Sook","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae-Ho","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea"},{"name":"Division of Pulmonary and Critical Care Medicine, Seoul National University College of Medicine, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In-Ae","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea"},{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1097\/MCO.0000000000000619","article-title":"Protein intake and outcome in critically ill patients","volume":"23","author":"Arabi","year":"2020","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e038532","DOI":"10.1136\/bmjopen-2020-038532","article-title":"Impact of carbohydrate-reduced nutrition in septic patients on ICU: Study protocol for a prospective randomised controlled trial","volume":"10","author":"Rahmel","year":"2020","journal-title":"BMJ Open"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Weijs, P.J., Mogensen, K.M., Rawn, J.D., and Christopher, K.B. (2019). Protein Intake, Nutritional Status and Outcomes in ICU Survivors: A Single Center Cohort Study. J. Clin. Med., 8.","DOI":"10.3390\/jcm8010043"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/S0261-5614(03)00129-8","article-title":"Muscle wasting and energy balance in critical illness","volume":"23","author":"Reid","year":"2004","journal-title":"Clin. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.ccc.2017.08.008","article-title":"Nutrition Therapy in Sepsis","volume":"34","author":"Wischmeyer","year":"2018","journal-title":"Crit. Care Clin."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1186\/s13054-014-0701-z","article-title":"Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients","volume":"18","author":"Weijs","year":"2014","journal-title":"Crit. Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1186\/s13054-016-1538-4","article-title":"Resting energy expenditure, calorie and protein consumption in critically ill patients: A retrospective cohort study","volume":"20","author":"Zusman","year":"2016","journal-title":"Crit. Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1177\/0148607115583675","article-title":"Clinical outcomes related to protein delivery in a critically ill population: A multicenter, multinational observation study","volume":"40","author":"Nicolo","year":"2016","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"De Waele, E., Malbrain, M.L., and Spapen, H. (2020). Nutrition in Sepsis: A Bench-to-Bedside Review. Nutrients, 12.","DOI":"10.3390\/nu12020395"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1007\/s00134-017-4683-6","article-title":"Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016","volume":"43","author":"Rhodes","year":"2017","journal-title":"Intensive Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.clnu.2018.08.037","article-title":"ESPEN guideline on clinical nutrition in the intensive care unit","volume":"38","author":"Singer","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1002\/ncp.10114","article-title":"Mueller CM, ed. The ASPEN Adult Nutrition Support Core Curriculum. 3rd ed. Silver Spring, MD: American Society for Parenteral and Enteral Nutrition; 2017. $280.00. 845 pp. Print ISBN: 978-1-889622-31-6; e-book ISBN: 978-1-889622-32-3","volume":"33","author":"LaRose","year":"2018","journal-title":"Nutr. Clin. Pract."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1097\/CCM.0000000000005357","article-title":"Executive Summary: Surviving Sepsis Campaign: International Guidelines for the Management of Sepsis and Septic Shock 2021","volume":"49","author":"Evans","year":"2021","journal-title":"Crit. Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1056\/NEJMoa1409860","article-title":"Trial of the Route of Early Nutritional Support in Critically Ill Adults","volume":"371","author":"Harvey","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta20280","article-title":"A multicentre, randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of early nutritional support via the parenteral versus the enteral route in critically ill patients (CALORIES)","volume":"20","author":"Harvey","year":"2016","journal-title":"Health Technol. Assess."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1016\/j.clnu.2016.06.010","article-title":"Indirect calorimetry in nutritional therapy. A position paper by the ICALIC study group","volume":"36","author":"Oshima","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1097\/MCO.0000000000000029","article-title":"Fundamental determinants of protein requirements in the ICU","volume":"17","author":"Weijs","year":"2014","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.clnu.2015.01.015","article-title":"Identifying critically-ill patients who will benefit most from nutritional therapy: Further validation of the \u201cmodified NUTRIC\u201d nutritional risk assessment tool","volume":"35","author":"Rahman","year":"2016","journal-title":"Clin. Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e206004","DOI":"10.1001\/jamanetworkopen.2020.6004","article-title":"Assessment of Health Care Exposures and Outcomes in Adult Patients With Sepsis and Septic Shock","volume":"3","author":"Fay","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Datta, A., Flynn, N.R., Barnette, D.A., Woeltje, K.F., Miller, G.P., and Swamidass, S.J. (2021). Machine learning liver-injuring drug interactions with non-steroidal anti-inflammatory drugs (NSAIDs) from a retrospective electronic health record (EHR) cohort. PLoS Comput. Biol., 17.","DOI":"10.1371\/journal.pcbi.1009053"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2204","DOI":"10.1109\/JBHI.2020.3033405","article-title":"\u2018Black Box\u2019to \u2018Conversational\u2019Machine Learning: Ondansetron Reduces Risk of Hospital-Acquired Venous Thromboembolism","volume":"25","author":"Datta","year":"2020","journal-title":"IEEE J. Biomed. Health Inform."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1053\/j.ajkd.2017.06.008","article-title":"Impact of Electronic Acute Kidney Injury (AKI) Alerts with Automated Nephrologist Consultation on Detection and Severity of AKI: A Quality Improvement Study","volume":"71","author":"Park","year":"2018","journal-title":"Am. J. Kidney Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1056\/NEJMoa1102662","article-title":"Early versus Late Parenteral Nutrition in Critically Ill Adults","volume":"365","author":"Casaer","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Bendavid, I., Zusman, O., Kagan, I., Theilla, M., Cohen, J., and Singer, P. (2019). Early Administration of Protein in Critically Ill Patients: A Retrospective Cohort Study. Nutrients, 11.","DOI":"10.3390\/nu11010106"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2130","DOI":"10.1001\/jama.2013.5124","article-title":"Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: A randomized controlled trial","volume":"309","author":"Doig","year":"2013","journal-title":"JAMA"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1177\/0148607115621863","article-title":"Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN)","volume":"40","author":"McClave","year":"2016","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Hung, K.-Y., Chen, Y.-M., Wang, C.-C., Wang, Y.-H., Lin, C.-Y., Chang, Y.-T., Huang, K.-T., Lin, M.-C., and Fang, W.-F. (2019). Insufficient Nutrition and Mortality Risk in Septic Patients Admitted to ICU with a Focus on Immune Dysfunction. Nutrients, 11.","DOI":"10.3390\/nu11020367"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1056\/NEJMoa1811687","article-title":"Energy-Dense versus Routine Enteral Nutrition in the Critically Ill","volume":"379","author":"Chapman","year":"2018","journal-title":"N. Engl. J. Med."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/11\/2318\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:22:58Z","timestamp":1760138578000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/11\/2318"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,31]]},"references-count":29,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["nu14112318"],"URL":"https:\/\/doi.org\/10.3390\/nu14112318","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,31]]}}}