Enteral and Parenteral Nutrition Timing in eICU Collaborative Research Database by Race: A Retrospective Observational Study

An-Kwok Ian Wong; Paul E Wischmeyer; Haesung Lee; Laura Gorenshtein; Trevor Sytsma; Sicheng Hao; Chuan Hong; Nrupen A Bhavsar; Ricardo Henao; Matt Maciejewski; Michael Pencina; Christopher E Cox; Joseph Fernandez-Moure; Suresh Agarwal; Krista Haines

doi:10.1016/j.jss.2024.10.021

Enteral and Parenteral Nutrition Timing in eICU Collaborative Research Database by Race: A Retrospective Observational Study

J Surg Res. 2024 Nov 16:304:181-189. doi: 10.1016/j.jss.2024.10.021. Online ahead of print.

Authors

Affiliations

¹ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina; Division of Translational Biomedical Informatics, Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina.
² Division of Critical Care Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina.
³ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina; Division of Medical Oncology, Department of Medicine, Duke University, Durham, North Carolina.
⁴ Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University, Durham, North Carolina.
⁵ Laboratory of Computational Physiology, Massachusetts Institute of Technology, Boston, Massachusetts.
⁶ Division of Translational Biomedical Informatics, Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina.
⁷ Division of Translational Biomedical Informatics, Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina; Division of Surgical Sciences, Department of Surgery, Duke University, Durham, North Carolina.
⁸ Department of Population Health Sciences, Duke University, Durham, North Carolina; Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina.
⁹ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina.
¹⁰ Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University, Durham, North Carolina. Electronic address: krista.haines@duke.edu.

PMID: 39551012
DOI: 10.1016/j.jss.2024.10.021

Abstract

Introduction: Racial and ethnic disparities in malnutrition are well-known, but it is unknown if there are disparities in early nutrition delivery for intensive care unit (ICU) patients, which is associated with better outcomes. We investigated the timing of enteral nutrition (EN) and parenteral nutrition (PN) initiation in the ICU, examining for racial differences.

Methods: Using the eICU-Collaborative Research Database (eICU-CRD) from 2014 to 2015, we analyzed patients eligible for EN and PN from 208 hospitals. EN and PN delivery was captured through intake/output entries. Exclusions included pre-existing EN/PN and short (<4 d) mechanical ventilation. Severity-of-illness was assessed using the sequential organ failure assessment (SOFA) score. Self-identified race was defined as the primary exposure, and Cox proportional hazards models were used to examine the association between race and time to EN and PN initiation, adjusting for patient, ICU, and hospital characteristics.

Results: Of 1914 patients from 14 hospitals with EN data (5.3% Black, 42.4% female, median age 65 y), 888 received EN. Among Black and White patients, the median [Q1, Q3] time from mechanical ventilation to EN was 1.5 [1.0, 2.8] d. Race was not associated with time until EN initiation (hazard ratio = 0.961, 95% confidence interval 0.693, 1.333). Rather, other variables including sex, SOFA score, hospital characteristics and ICU unit type appeared to account for variation in EN initiation. Among 31,551 patients from 59 hospitals with PN data (11.3% Black, 45.1% female, median age 67 y), 1140 received PN, with a median [Q1, Q3] time to PN initiation of 7.4 [4.2, 12.4] d amongst Black and White patients. Race was not associated with time until PN initiation (hazard ratio = 1.095, 95% confidence interval = 0.901, 1.331). Instead, sex, body mass index, SOFA score, hospital characteristics and ICU unit type appeared to account for variation in PN initiation.

Conclusions: Disparities in EN and PN delivery in the eICU-CRD dataset from 2014 to 2015 were not associated with race, but rather with sex, body mass index, SOFA, hospital characteristics and ICU unit type. Further investigations using more current data are needed.

Keywords: Data science; Disparities; Electronic health record; Enteral nutrition; Intensive care; Parenteral nutrition; Perioperative nutrition.