{
  "abstract": "Objectives Enteral nutrition (EN) constitutes a critical therapeutic intervention in the management of patients with sepsis; however, the optimal timing for its initiation remains uncertain. This study sought to evaluate the impact of early versus delayed EN on mortality rates and clinical outcomes among adult patients with sepsis in intensive care units (ICU).Design Retrospective cohort study using propensity score matching (PSM) methodology.Setting A tertiary hospital ICU in Hebei Province, China, from 2015 to 2024.Participants This retrospective analysis involved adult ICU patients with sepsis (meeting Sepsis 3.0 criteria) from January 2015 to December 2024 who began EN within 7 days of admission. Patients were classified into early (within 2 days) or delayed (2–7 days) EN groups based on when nutrition was initiated.Primary and secondary outcome measures Primary outcomes were 28-day and 60-day mortality, with secondary outcomes including hospital/ICU stay length, mechanical ventilation duration and nutrition-related complications.Results A study of 2205 patients compared early EN (EEN) in 1500 patients (68.0%) with delayed EN in 705 patients (32.0%). After PSM, the EEN group showed a higher mortality risk at 28 days (HR 1.44, 95% CI 1.08 to 1.92) and 60 days (HR 1.45, 95% CI 1.11 to 1.89), confirmed by multivariable Cox regression and inverse probability weighting. EEN patients also had more gastric retention (OR 1.77, 95% CI 1.14 to 2.79). The increased mortality risk was notably pronounced in younger male patients with a body mass index of less than 24 kg/m², abdominal infections, those with severe sepsis and patients necessitating vasopressor support at a norepinephrine equivalent of ≥0.1 µg/kg/min. Sensitivity analyses supported these findings.Conclusions Our retrospective analysis of 2205 propensity score-matched patients with sepsis found that EEN is linked to higher short-term mortality, especially in younger males, those with severe illness, abdominal infections or needing moderate to high vasopressor support. This suggests that personalised nutritional timing might be better than universal early feeding. However, these findings are preliminary and need confirmation through randomised controlled trials.",
  "authors": [
    {
      "affiliations": [
        "Department of Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China"
      ],
      "name": "Li Li"
    },
    {
      "affiliations": [
        "Department of Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China"
      ],
      "name": "Hui Chen"
    },
    {
      "affiliations": [
        "Department of Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China"
      ],
      "name": "Yang Liu"
    },
    {
      "affiliations": [
        "Department of Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China"
      ],
      "name": "Kun Zhao"
    },
    {
      "affiliations": [
        "Department of Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China"
      ],
      "name": "Manli Zhang"
    },
    {
      "affiliations": [
        "Department of Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China"
      ],
      "name": "Fei Tong"
    }
  ],
  "title": "Early versus delayed enteral nutrition in patients with sepsis: a propensity score-matched cohort study at a tertiary hospital in Hebei, China",
  "uid": "3074df3a-74d4-50b8-bc49-0661df0791aa"
}