Internal Medicine · 3 h ago
Creatinine production rate did not identify ICU patients benefiting from early parenteral nutrition
A secondary analysis of the EPaNIC randomized trial examined whether day-2 creatinine production rate (CPR) could identify ICU patients who benefited from early parenteral nutrition. CPR did not identify a subgroup benefiting from early nutrition; patients with higher CPR had a lower likelihood of earlier ventilator weaning with early versus late parenteral nutrition.
- Secondary analysis of the 4,640-patient EPaNIC trial
- Day-2 CPR did not identify patients benefiting from early-PN
- High CPR groups had less favorable ventilator-weaning outcomes
- Ventilator-weaning duration was used as a surrogate
Researchers conducted a secondary analysis of the EPaNIC randomized trial, comparing early parenteral nutrition (early-PN) with withholding parenteral nutrition for one week (late-PN). The analysis included 4,640 trial participants, excluding patients receiving renal replacement therapy. CPR and body-size-corrected CPR index were assessed, with duration of mechanical ventilation used as a surrogate for muscle weakness. Day-2 CPR data were available for 1,322 early-PN and 1,382 late-PN patients.
CPR and CPR-index values were higher with early-PN than late-PN from ICU days 4 to 11. Day-2 CPR and CPR-index showed statistical interactions with treatment assignment, although the interaction P values (0.067 and 0.058) did not meet the study’s conventional 0.05 threshold. Among patients with above-mean CPR, early-PN was associated with a lower likelihood of earlier live ventilator weaning (adjusted hazard ratio 0.871; 95% CI, 0.778–0.981); a similar finding was reported for above-mean CPR-index (0.858; 95% CI, 0.764–0.963). No corresponding differences were observed in the low-value groups.
The authors concluded that day-2 CPR and CPR-index did not identify ICU patients who could benefit from early intensive nutritional therapy. These findings come from a secondary analysis and use ventilator weaning as a surrogate outcome; they do not establish CPR as a basis for individualizing nutrition.
In practice
For critically ill adults similar to those in EPaNIC, this secondary analysis does not support using day-2 CPR or CPR-index to select patients for early parenteral nutrition. In the above-mean CPR groups, early-PN was associated with a lower likelihood of earlier live ventilator weaning, while no such difference was reported in the lower-value groups. The subgroup interactions were borderline by conventional significance criteria, and ventilator weaning was a surrogate outcome; the analysis does not establish a biomarker-guided treatment strategy.
AI-generated clinical interpretation · Not editor-reviewed
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Critical Care: Assessment of creatinine production rate as a predictive biomarker to individualize nutrition in the ICU: a secondary analysis of the EPaNIC-RCT ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.