BackgroundHigh-risk open abdomen (OA) patients with acute gastrointestinal injury (AGI) and persistent enteral nutrition (EN) intolerance are particularly vulnerable to cumulative energy-protein deficit, yet the optimal timing of supplemental parenteral nutrition (SPN) remains uncertain. We evaluated whether earlier SPN initiation was associated with a lower subsequent incidence of enteroatmospheric fistula (EAF) in this population.MethodsWe conducted a single-center retrospective cohort study of adult OA patients admitted to the intensive care unit between January 2019 and December 2024 who had AGI grade II-III, persistent EN intolerance by ICU Day 3, and a modified Nutrition Risk in the Critically Ill score of at least 5. Using ICU Day 7 as the landmark time point, patients who initiated SPN between ICU Days 3 and 7 were classified as the early-SPN group, and those who initiated SPN after ICU Day 7 as the late-SPN group. Patients who never received SPN were intentionally excluded to focus the analysis on the optimal timing among those who definitively required supplementation. One-to-one propensity score matching was performed. The primary outcome was EAF occurring after ICU Day 7.ResultsAmong 355 screened patients, 284 met the eligibility criteria, including 110 early-SPN and 174 late-SPN patients; 102 matched pairs were analyzed. During ICU Days 3–7, the early-SPN group received higher energy and protein delivery. EAF occurred in 13/102 patients (12.75%) in the early-SPN group and 31/102 (30.39%) in the late-SPN group (relative risk, 0.42; 95% CI, 0.23–0.75; p = 0.002). In an exploratory landmark time-to-event analysis, early SPN was associated with a lower subsequent hazard of EAF (HR, 0.39; 95% CI, 0.21–0.75; log-rank p = 0.003). Mechanical ventilation duration was shorter in the early-SPN group (8.27 ± 10.53 vs. 12.00 ± 13.80 days, p = 0.031), whereas other secondary outcomes were comparable.ConclusionAmong high-risk OA patients with AGI and persistent EN intolerance who subsequently required SPN, initiation of SPN between ICU Days 3 and 7 was associated with improved short-term nutritional delivery, shorter mechanical ventilation duration, and a lower subsequent incidence of EAF than later SPN initiation.

Abstract Background Bloodstream infection (BSI) is a common complication of gastrointestinal fistula, leading to adverse outcomes. Whether a bloodstream infection is caused by an ectopic intra-abdominal infection, i.e. whether it is intra-abdominal/intestinal borne, may affect the patient's prognosis. In this study, we will analyze the value of consistency between blood culture and abdominal drain culture in predicting adverse outcomes in critically ill gastrointestinal fistula patients with BSI. Material and methods A retrospective analysis was performed in 295 patients with gastrointestinal fistula recruited in intensive care unit (ICU) of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine. In which, a highly selected population who were identified with BSI were involved and divided into a consistent group (one or more microorganisms isolated from blood cultures were same with microorganisms isolated from abdominal drain cultures) and an inconsistent group (all microorganisms isolated from blood cultures were different with microorganisms isolated from abdominal drain cultures). Results Consistent group accounted for 41.57% (37/89) of all BSI patients with significantly higher in-hospital mortality (48.65% vs. 15.38%, P = 0.001). Meanwhile, a 90-days prognosis analysis indicated that consistent group showed inferior survival benefits than inconsistent group. Consistent group was more likely to sufferer from Gram-negative bacteria (P = 0.001) and fungi (P = 0.031) infection in blood cultures. Frequency of Acinetobacter baumannii and Enterococcus were significantly higher in consistent group, both in blood and abdominal drain cultures. In multivariate analysis, consistent microorganism isolated from blood and abdominal drain cultures (OR = 4.320 [1.536–12.153]; P = 0.006) and vasopressors (OR = 6.784 [1.416–32.488]; P = 0.017) were identified as independent risk factors for mortality. Conclusion Consistent microorganism isolated from blood and abdominal drain cultures is an independent risk factor for mortality in critically ill gastrointestinal fistula patients with BSI.

Abstract Background The COVID-19 pandemic has spread rapidly worldwide, highlighting the vulnerability of elderly individuals with frailty as a risk factor for adverse outcomes. Aim This study was designed to investigate whether early and appropriate nutritional intervention can mitigate skeletal muscle mass loss and improve clinical outcomes in frail older adults compared with standard hospital diet. Methods A randomized controlled trial was conducted in a general hospital in China from January to March 2023. Eligible patients provided informed consent and were randomly assigned to either the hospital diet group or the optimized diet group. The primary endpoint of the study was ΔSMI (change in skeletal muscle index between day 7 post-feeding and admission). Secondary endpoints included several indicators of body composition such as fat-free mass (FFM), skeletal muscle mass (SMM), extracellular water/total body water ratio (ECW/TBW), visceral fat area (VFA), and phase angle. Clinical outcomes were mortality, intensive care unit (ICU) admission, and length of hospital stay. Results Fifty-five patients were recruited and analyzed between January and March 2023. Patients in the optimized diet group received a mean of 1.0 (SD 0.06) g/kg per day protein compared with 0.8 (SD 0.07) g/kg per day in the hospital diet group (P = 0.02). The average daily intake over 7 days was 26 (SD 6.1) kcal/kg for the optimized diet group and 21 (SD 7.2) kcal/kg for the hospital diet group(P = 0.0171). Both groups showed a reduction in skeletal muscle index (SMI), with participants receiving the optimized diet intervention showing a comparatively smaller decrease in SMI compared to those on the hospital diet (0.57 [SD 0.08] kg/m2 vs. 0.16 [SD 0.07] kg/m2, P = 0.0003). The other parameters, including fat-free mass, visceral fat area, ECW/TBW ratio, and phase angle, did not show significant differences between the two groups. During hospitalization, two patients in the hospital diet group and one patient in the optimized diet group succumbed to respiratory failure as the direct cause of death. However, there was no statistically significant difference in mortality between the two groups (P > 0.99). The mean duration of hospital stay for patients in the optimized diet group was 12.3 days, which was significantly shorter compared to the hospital diet group with a mean duration of 14.4 days (P = 0.0211). Conclusions Our study results suggest that early, appropriate, and rational optimization of diet may mitigate short-term muscle mass loss while reducing hospital stay.

Background: To delineate the clinical characteristics of intestinal fistula patients with Bloodstream infection (BSI). Methods: Retrospective case series in Surgical Intensive Care Unit (SICU), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. Among a cohort of 204 patients with a diagnosis of intestinal fistula, 46 who were complicated with BSI were analysed retrospectively. Data was collected from January 1, 2018 to February 1, 2020. Results: Among the 204 patients with intestinal fistula, 46 patients showed positive blood cultures, which clearly had BSIs. Parenteral nutrition (PN) time (OR 1.08, 95% CI 1.04 similar to 1.12, P < 0.01), transferred from external ICU (OR 3.68, 95% CI 1.48 similar to 9.17, P = 0.01), septic shock (OR 4.61, 95% CI 1.77 similar to 11.97, P < 0.01), APACHE II (OR 1.11, 95% CI 1.01 similar to 1.22, P = 0.04) were significantly associated with BSI in patients with intestinal fistula. When APACHE II score exceeds 12.0 points or PN time exceeds 18.0 D, the chance of BSI in patients with intestinal fistula increases significantly. In addition, compared with the non-BSI group, BSI group had a higher mortality and expenses in ICU, longer stay in ICU and total hospital stay, and worse quality of life (all P < 0.05). A total of 105 isolates from samples (including sputum, pus and blood) of 46 patients in the BSI group, among which were mainly gram negative rods and fungi, as well as blood isolates. Importantly, in patients with intestinal fistula, BSIs caused by fungi accounted for 23.4%. Conclusion: Long-term PN, transfer from external ICU, septic shock, and higher APACHE II scores are often associated with an increased probability of BSIs in patients with intestinal fistula and a higher mortality. Gram-negative bacteria are the main pathogenic bacteria in intestinal fistula patients with BSI, and patients with intestinal fistula are more likely to develop fungal BSIs. (C) 2021 The Authors. Published by Elsevier Inc.

Iron may be involved in the etiology of inflammatory bowel disease (IBD) and chronic diarrhea by modulating gut microbiota and immune responses, but data from epidemiological studies in adults examining this relationship are limited. Thus, the aim of this study was to evaluate the association between iron intake and serum iron levels with IBD and chronic diarrhea in adults. Data from the National Health and Nutritional Examination Surveys (NHANES) between 2007 and 2010 for adults ≥ 20 years were obtained. Chronic diarrheal symptoms were determined by using the 2007–2010 NHANES questionnaire which included questions pertaining to bowel health. The presence of IBD was analyzed from the NHANES data, directly querying the presence or absence of ulcerative colitis (UC) and Crohn’s disease (CD). A total of 9605 participants were initially included in this study. Multivariable logistic regression analysis was used and stratified by gender. Compared with quartile 1 (the lowest quartile), the multivariate-adjusted ORs (95% CI) for risk of having chronic diarrheal symptoms were 1.01 (0.86–1.18), 1.29 (1.07–1.56) and 1.25 (1.02–1.54) across quartiles 2 to 4 of iron intake. This significant association remained among men, but not among women in subgroup analyses. No significant association between either iron intake or serum iron level and the risk of IBD was observed. Generally, there was a positive association between iron intake and chronic diarrheal symptoms in adults that was modified by sex.

目的 探讨不同营养支持方式在重症急性胰腺炎及腹腔感染所致的腹腔开放(o pen abdomen,OA)病人中的应用和对病人预后的影响.方法 回顾性纳入自2016年1月至2020年12月上海交通大学医学院附属第九人民医院普外科重症监护室所收治的因重症急性胰腺炎和腹腔感染行OA治疗的病人25例.回顾病人病程中的营养支持方式并将病人分为单纯肠内营养组(enteral nutrition,EN,8例)及EN联合全肠外营养(total parenteral nutrition,EN+TPN,17例),比较两组病人一般临床资料、热卡达标率、胃肠道功能障碍及临床预后的差异.结果 两组病人年龄、性别、原发病、合并症、疾病危重度、静息能量消耗、感染指标、肝肾功能、凝血功能等差异均无统计学意义(均P>0.05).热卡达标率比较,EN组早期热卡达标率显著低于EN+T PN组(营养支持第5、7、11天比较,均P<0.05),平均达标时间显著长于EN+TPN组(P=0.005).胃肠道功能障碍比较中,EN+T PN组消化道麻痹发生率显著高于EN组(37.5％ 比82.4％,P=0.024).临床预后比较,两组死亡率差异无统计学意义(P>0.05),EN组住院总费用显著低于EN+TPN组(P=0.045).结论 OA病人给予单纯EN的营养支持方式是安全可行的,虽然额外添加T PN能早期达到热卡目标,但并未能让病人获益.