Nutritional Risk and 30-Day In-Hospital Mortality in Adults With Sepsis and Septic Shock: A Retrospective Cohort Study.

BACKGROUND

Despite the improvements in the management of sepsis, mortality remains high. Understanding the significance of nutritional status on mortality is vital for advancing therapeutic interventions. The aim of this study was to evaluate the relationship between patients' nutritional status during their stay in intensive care unit (ICU) and 30-day in-hospital mortality among adults admitted with sepsis and septic shock.

METHODS

A retrospective cohort study was carried out at a single tertiary institution in South Korea between January 2015 and December 2024. The inclusion of a sample of 355 ICU patients suffering from sepsis or septic shock who survived the first seven days of the study and received enteral nutrition was a part of the study, comprising 247 survivors and 108 nonsurvivors. Data included baseline characteristics, as well as clinical and nutritional parameters collected throughout the ICU stay.

RESULTS

A 30-day in-hospital mortality rate of 30.4% was observed among patients with sepsis and septic shock. Each 10% increase in protein adequacy during ICU Days 4-7 was linked to a 9% lower hazard of 30-day in-hospital mortality (p = 0.043). A high nutritional risk, as defined by a modified Nutrition Risk in the Critically Ill (mNUTRIC) score, was independently associated with a 68% higher hazard of 30-day in-hospital mortality (p = 0.041). The use of continuous renal replacement therapy (p = 0.003), serum lactate ≥ 2 mmol/L on Day 7 (p < 0.001), and mean arterial pressure < 65 mmHg on Day 7 (p = 0.047) were also linked to a higher risk of 30-day in-hospital mortality.

CONCLUSIONS

The nutritional status of patients with sepsis and septic shock during their stay in the ICU was found to be a significant factor in determining 30-day in-hospital mortality. Integrating nutritional and physiological indicators could help identify patients at greater risk of mortality and inform continued nutritional monitoring in the intensive care setting.

IMPLICATION FOR NURSING MANAGEMENT: Our findings highlight the clinical importance of monitoring protein adequacy throughout the ICU care of patients with sepsis and septic shock. Nurse managers should promote standardized nutritional screening, systematic intake monitoring, and multidisciplinary collaboration to support timely, individualized nutrition care.