ESPEN 2011 Late breaking abstract submission

Topic: Late Breaking Abstract

Abs n°:ESPEN11-2107

Abs Title: EFFECT OF ENTERAL PHARMACONUTRITION ON ORGAN DYSFUNCTION IN SEPTIC PATIENTS

K. Lei ^{1 2,*}H. Schneider ³W. Venetz ⁴R. Beale ^{1 2 5}

¹King’s Health Partners, ²Department of Adult Critical Care, Guy's and St. Thomas' NHS Hospital Trust, London, United Kingdom, ³HEALTHECON AG, Basel, ⁴Datagen AG, Rheinfelden, Switzerland, ⁵Division of Asthma, Allergy and Lung Biology, King’s College, London, United Kingdom

Rationale: To confirm previous findings that early enteral supply of Intestamin to critically ill, septic patients results in a significantly faster reduction of organ dysfunction as represented by daily SOFA scores  during the first 10 treatment days compared with control.

Methods: In a prospective, randomized, controlled, double-blind clinical trial, 64 patients (ITT) received either an enteral supplement (500 mL of Intestamin, Fresenius Kabi) containing conditionally essential nutrients or a control solution via the nasogastric route for 10 days. Inclusion occurred within 24 hrs of ICU admission. Additionally, patients received a standard enteral formula initiated within 48 hrs after enrollment. Organ dysfunction was assessed by daily total Sequential Organ Failure Assessment (SOFA), and the regression coefficients of delta daily total SOFA score for the two groups were compared using Student’s t-tests.

Results: Patients receiving Intestamin showed a significantly faster decline in the regression slopes of delta daily total SOFA score over time when compared with control patients. The difference between the  two slopes was statistically significant: intent to treat -0.45 vs. -0.31, p = .0011; per protocol -0.49 vs. -0.29, p < .0001. Vitamin C, as a marker of supplement absorption, increased from 20.6 (sd 22.2) µmol/L (normal range 20-50 µmol/L) on day 1 to 82.3 (sd 44.0) µmol/L by day 5 (p < .0001) in the intervention group but remained unchanged in the control group 43.8 (sd 65.2) on day 1 and 42.1 (sd 57.4) on day 5. Serum levels of serine, ornithine and selenium increased significantly with treatment in the Intestamin group.

Conclusion: These results confirm that in septic patients, early enteral supplementation with glutamine dipeptides, vitamin C and E, beta-carotene, selenium, zinc, and tributyrin in combination with a standard enteral formula results in significantly faster recovery of organ function compared to control.

Disclosure of Interest: K. Lei: None DeclaredH. Schneider Consultant for: Fresenius KabiW. Venetz: None DeclaredR. Beale Grant/Research Support from: Fresenius Kabi

Keywords: organ dysfunctionpharmaconutrition