The effect of nutritional supplementation on survival in seriously ill hospitalized adults: An evaluation of the SUPPORT data

BACKGROUND: Enteral tube and parenteral hyperalimentation are widely used n utritional support systems. Few studies examine the relation between nutrit ional support and patient outcomes in seriously ill hospitalized adults. OBJECTIVE: To explore the association between nutritional support and survi val in seriously ill patients enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). DESIGN: A prospective study of preferences, decisionmaking, and outcomes. SETTING: Five teaching hospitals PARTICIPANTS: 6298 patients aged 18 or older meeting diagnostic and illness severity criteria. MEASUREMENT: Demographic characteristics, diagnoses, comorbid conditions, a cute physiology score, nutritional support, and functional status before ho spitalization. RESULTS: A total of 2149 patients received nutritional support. In patients who received artificial nutrition on hospital days 1 or 3 (Cohort 1), ente ral feeding was associated with improved survival in coma (hazard: 0.53; 95 % CI, 0.42-0.66), and reduced survival in COPD (hazard: 1.57; 95% CI, 1.18- 2.08). In patients who were hospitalized on Day 7 and received artificial n utrition on days 1, 3, or 7 (Cohort 2), enteral tube feeding (hazard: 0.35; 95% CI, 0.27- 0.46) or hyperalimentation (hazard: 0.58; 95% CI, 0.38-0.90) was associated with improved survival in coma. Tube feeding was associated with decreased survival in acute respiratory failure (ARF) or multiorgan s ystem failure (MOSF) with sepsis (hazard: 1.21; 95% CI, 10.4-1.41), cirrhos is (hazard: 2.15; 95% CI, 1.35-3.42), and COPD (hazard: 1.37; 95% CI, 1.04- 1.80). Hyperalimentation was associated with decreased survival in ARF or M OSF with sepsis (hazard: 1.34; 95% CI, 1.12-1.59). CONCLUSIONS: Nutritional support was associated with improved survival in c oma. Enteral feeding and hyperalimentation was associated with decreased su rvival in ARF or MOSF with sepsis. Tube feeding was associated with decreas ed survival in cirrhosis and COPD. Except for patients in coma, artificial nutrition was not associated with a survival advantage.