Effect of nutritional support in patients with lower respiratory tract infection: Secondary analysis of a randomized clinical trial - Baumgartner, A.; Hasenboehler, F.; Cantone, J.; Hersberger, L.; Bargetzi, A.; Bargetzi, L.; Kaegi-Braun, N.; Tribolet, P.; Gomes, F.; Hoess, C.; Pavlicek, V.; Bilz, S.; et al. (Clin Nutr, 2020)
BACKGROUND: In polymorbid patients with bronchopulmonary infection, malnutrition is an independent risk factor for mortality. There is a lack of interventional data investigating whether providing nutritional support during the hospital stay in patients at risk for malnutrition presenting with lower respiratory tract infection lowers mortality. METHODS: For this secondary analysis of a randomized clinical trial (EFFORT), we analyzed data of a subgroup of patients with confirmed lower respiratory tract infection from an initial cohort of 2028 patients. Patients at nutritional risk (Nutritional Risk Screening [NRS] score >/=3 points) were randomized to receive protocol-guided individualized nutritional support to reach protein and energy goals (intervention group) or standard hospital food (control group). The primary endpoint of this analysis was all-cause 30-day mortality. RESULTS: We included 378 of 2028 EFFORT patients (mean age 74.4 years, 24% with COPD) into this analysis. Compared to usual care hospital nutrition, individualized nutritional support to reach caloric and protein goals showed a similar beneficial effect of on the risk of mortality in the subgroup of respiratory tract infection patients as compared to the main EFFORT trial (odds ratio 0.47 [95%CI 0.17 to 1.27, p = 0.136] vs 0.65 [95%CI 0.47 to 0.91, p = 0.011]) with no evidence of a subgroup effect (p for interaction 0.859). Effects were also similar among different subgroups based on etiology and type of respiratory tract infection and for other secondary endpoints. CONCLUSION: This subgroup analysis from a large nutrition support trial suggests that patients at nutritional risk as assessed by NRS 2002 presenting with bronchopulmonary infection to the hospital likely have a mortality benefit from individualized inhospital nutritional support. The small sample size and limited statistical power calls for larger nutritional studies focusing on this highly vulnerable patient population. CLINICAL TRIAL REGISTRATION: Registered under ClinicalTrials.gov Identifier no. NCT02517476.
Keywords: journalArticle; (1410.000.058 and 1410.000.044). The institution of P.Schuetz has previously; Aged; Cohort Studies; Comorbidity; Covid19; Female; Fresenius Kabi. All other authors report no conflicts of interest; Hospitalization/statistics & numerical data; Humans; Male; Malnutrition; Malnutrition/*diet therapy/*epidemiology; Middle Aged; Nutritional Support/*methods; Nutritional support; Outcome; Professorship, PP00P3_150531) and the Forschungsrat of the Kantonsspital Aarau; Randomized trial; Respiratory Tract Infections/*epidemiology; Respiratory infection; Science and Abbott Nutrition. The institution of Z.Stanga received speaking; Switzerland/epidemiology; grant from the Swiss National Science Foundation to P.Schuetz (SNSF; honoraria and research support from Neste Health Science, Abbott Nutrition and; received unrestricted grant money unrelated to this project from Neste Health