Early energy delivery and 28-day mortality in critically ill patients with sepsis: Post hoc analysis of a multicenter cluster-randomised controlled trial.

BACKGROUND

Sepsis remains a leading cause of mortality in intensive care units (ICU), but optimal energy delivery strategies remain unclear. This post hoc analysis examines the association between early energy delivery and 28-day all-cause mortality in ICU patients with sepsis.

METHODS

This post hoc analysis of the multicentre NEED trial (ISRCTN12233792) included ICU patients with sepsis and ≥ 7-day stays. Early energy delivery (first 7 days) was calculated as a percentage of the target 25 kcal/kg ideal body weight. Patients were stratified by mNUTRIC score (<5 vs ≥5). Associations with 28-day mortality were assessed using Cox models and Kaplan-Meier analysis, with subgroup and spline analyses exploring effect modification and nonlinearity.

RESULTS

This analysis included 1162 sepsis patients (median age 66.0 years, 66.3 % male), with 183 (15.7 %) patients deceased within 28-day after ICU admission. The optimal energy delivery thresholds were identified as 100 % of the target for low-risk and 60 % for high-risk patients. Cox proportional hazards models further confirmed that in the high-risk group, achieving≥60 % of the target was associated with a lower 28-day mortality risk (hazard ratio = 0.588, 95 % conficence interval: 0.388-0.891), whereas no benefit was observed in low-risk patients. Additionally, no significant interactions were found in subgroup analyses. Restricted cubic spline analysis suggested a downward trend in mortality risk with increasing energy delivery in high-risk patients (P-nonlinear = 0.063).

CONCLUSIONS

Early energy delivery ≥60 % of target is linked to lower 28-day mortality in high-risk sepsis patients, with no clear benefit in low-risk groups. These results support risk-based nutritional strategies in sepsis care.

TRIALS REGISTRATION: ISRCTN 12233792, registered on November 24, 2017.