Influence of early enteral nutrition on mortality of adult patients with sepsis: a meta-analysis of randomized controlled trials.

BACKGROUND

Early enteral nutrition (EEN) has been proposed to improve clinical outcomes in critically ill patients with sepsis. However, the survival benefit of EEN remains uncertain. This meta-analysis aimed to evaluate the effect of EEN on all-cause mortality in adult patients with sepsis.

METHODS

A systematic search of PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang was conducted up to May 25, 2025. Randomized controlled trials (RCTs) comparing EEN (initiated within 24-48 h of admission or sepsis diagnosis) vs. non-early enteral nutrition (delayed enteral nutrition or parenteral nutrition) in adult septic patients were included. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model by incorporating the influence of potential heterogeneity.

RESULTS

Ten RCTs involving 582 patients (281 EEN, 301 controls) were included. Compared to controls, EEN significantly reduced all-cause mortality (OR: 0.59; 95% CI 0.37-0.94; p = 0.03), with no significant statistical heterogeneity (I2 = 0%). Sensitivity analyses yielded consistent results (OR range: 0.48-0.67; all p < 0.05). Subgroup analyses showed the mortality benefit of EEN was consistent across subgroups defined by sepsis severity (OR: 0.61 vs. 0.56), sepsis diagnostic criteria (Sepsis-1.0/2.0: OR 0.83 vs. Sepsis-3.0: OR 0.51), patient age, sex distribution, EEN initiation time (within 24 vs. 48 h), and mortality follow-up duration (p for subgroup difference all > 0.05).

CONCLUSIONS

EEN significantly reduces mortality in adult patients with sepsis. High-quality RCTs are warranted to determine the optimal regimen of EEN in this population.