Parenteral And Enteral Nutrition Support Inpatient Clinical Outcomes Of Nutritional Risk: China And The United States Teaching Hospitals In Multi-center Cohort Study

Background:Nutritional Risk Screening Tool 2002(NRS-2002) was recommended by E(?)can Socitey of Parenteral and Enteral Nutrtition for use in hospitalized patients.Th(?)as no prospective study on the effect of parenteral nutrition and enteral nutrition on(?)l outcome in patients at nutritional risk defined by NRS-2002,also no such data(?)e patients in China and the United States.The aim of this study was to compare(?) nutritional risk status and application of nutritional support in teaching hospita(?) China and the United States,to evaluate the effect of parenteral nutrition/enteral nutr(?)n clinical outcomes in patient at nutritional risk.Methods:In this prospective cohort study,patients admitted to departments of gastro(?)nal medicine,respiratory medicine and abdominal surgery in the Johns Hopkins H(?)al (JHH) in Baltimore in the US,in the Peking Union Medical College Hospital(PUMCH) and Beijing University Third Hospital(BUTH) in Beijing,China were recruited and received nutritional risk screening using NRS-2002 on admission.A NRS score of≥3 means at nutritional risk.Patients were monitored daily until discharge to collect data on the application of parenteral nutrition(PN) and enteral nutrition(EN),treatment(?)rgery, complications,mortality and length of stay(LOS).Results:1.The difference between the teaching hospitals in Beijing and Baltimore:Totally 1041 patients were recruited.The rate of nutritional risk was similar between PUMC(?)d JHH(P=0.15),although the rate of obesity was significantly higher in JHH(P＜(?)1). Among the medical patients,there was more frequent use of PN and less freq(?)se of EN in PUMCH(P=0.01).The application rate of nutritional support was sign(?)tly higher in PUMCH in surgical patients at no nutritional risk(P＜0.001),especi(?) patients undergoing gastrointestinal surgery(P＜0.001).3.The impact of parenteral/enteral nutrition on clinical outcomes:Totally 18(?)tients were recruited.Among the "at risk" patients(n=827),the complication rate wa(?)er in the "nutritional support" group than that in the "no support" group(P=0.009),(?)ainly because of the significantly reduced rate of infectious complications(P＜0.001).Among the "at risk" patients with obviously reduced oral intake before admission,the association of nutritional support and the reduced rate of infectious complications was obs(?) in each hospital(P=0.004,0.04,0.03,respectively).In addition,the complicati(?)te was significantly lower in the patients who received EN but not in the patients who received PN when compared to the "no support" group.Among the patients without nutritional risk(n=1004),the complication rate was not different between the "nutritional support" group and the "no support" group(P=0.12).The multivariate analysis showed nutrition support was a protective factor for complication rate in the "at risk" patients when adjusted for confounders(odds ratio:0.54,P＜0.001).4.the impact of preoperative nutritional support on clinical outcomes:Among the patients with NRS score of≥5(n=127),the complication rate was lower in the "preoperative nutrition" group compared to the control group(P=0.009).The postoperative hospital stay was 4 days shorter in the "preoperative nutrition" group (P=0.03),while the LOS was similar in the two groups(P=0.84).Among the patients with NRS score of 3-4(n=429),the complication rate and postoperative hospital stay was similar between patients with or without preoperative nutrition(P=0.96,0.77).Conclusions:1.The rate of nutritional risk was similar between Beijing and Baltimore while there was more obesity in Baltimore.2.Parenteral nutrition was overused in Beijing in surgical patients at no nutritional risk, especially among those undergoing gastrointestinal surgery.However,no effect of nutritional support on clinical outcome was found among the patients at no nutritional risk in this study.3.Among the medical patients,there was more frequent use of PN and less frequent use of EN in Beijing when compared to Baltimore.It revealed that EN was associated with significantly reduced complication rate in this study.4.This finding revealed that nutritional support was beneficial to the patients at nutritional risk by reduced rate of infectious complications,especially among the patients with obviously reduced oral intake before admission.5.It suggests that preoperative nutritional support is beneficial to the patients with NRS score of≥5 by reduced complication rate.