Exploring the impact of arginine-supplemented immunonutrition on length of stay in the intensive care unit: A retrospective cross-sectional analysis

PLoS One. 2024 Apr 26;19(4):e0302074. doi: 10.1371/journal.pone.0302074. eCollection 2024.

Abstract

Background: Arginine-supplemented enteral immunonutrition has been designed to optimize outcomes in critical care patients. Existing formulas may be isocaloric and isoproteic, yet differ in L-arginine content, energy distribution, and in source and amount of many other specialized ingredients. The individual contributions of each may be difficult to pinpoint; however, all cumulate in the body's response to illness and injury. The study objective was to compare health outcomes between different immunonutrition formulas.

Methods: Real-world data from October 2015 -February 2019 in the PINC AI™ Healthcare Database (formerly the Premier Healthcare Database) was reviewed for patients with an intensive care unit (ICU) stay and ≥3 days exclusive use of either higher L-arginine formula (HAF), or lower L-arginine formula (LAF). Multivariable generalized linear model regression was used to check associations between formulas and ICU length of stay.

Results: 3,284 patients (74.5% surgical) were included from 21 hospitals, with 2,525 receiving HAF and 759 LAF. Inpatient mortality (19.4%) and surgical site infections (6.2%) were similar across groups. Median hospital stay of 17 days (IQR: 16) did not differ by immunonutrition formula. Median ICU stay was shorter for patients receiving HAF compared to LAF (10 vs 12 days; P<0.001). After adjusting for demographics, visit, severity of illness, and other clinical characteristics, associated regression-adjusted ICU length of stay for patients in the HAF group was 11% shorter [0.89 (95% CI: 0.84, 0.94; P<0.001)] compared to patients in the LAF group. Estimated adjusted mean ICU length of stay was 9.4 days (95% CI: 8.9, 10.0 days) for the HAF group compared to 10.6 days (95% CI: 9.9, 11.3 days) for the LAF group (P<0.001).

Conclusions: Despite formulas being isocaloric and isoproteic, HAF use was associated with significantly reduced ICU length of stay, compared to LAF. Higher arginine immunonutrition formula may play a role in improving health outcomes in primarily surgical critically ill patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Arginine* / administration & dosage
  • Arginine* / therapeutic use
  • Critical Illness / therapy
  • Cross-Sectional Studies
  • Dietary Supplements
  • Enteral Nutrition* / methods
  • Female
  • Hospital Mortality
  • Humans
  • Immunonutrition Diet
  • Intensive Care Units*
  • Length of Stay*
  • Male
  • Middle Aged
  • Retrospective Studies

Substances

  • Arginine

Grants and funding

This study was sponsored and funded by Nestlé Healthcare Nutrition, Inc. (https://www.nestlehealthscience.us/). Nestlé Healthcare Nutrition, Inc is the legal entity in the United States for the Medical Nutrition category of Nestlé Health Science. Publication of the study results was not contingent on the sponsor’s approval or censorship of the manuscript. The funder provided support in the form of salaries for authors MKM, AMD, CCL, and KAT but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Premier Inc provided support in the form of salaries for authors LLS and ZC but did not have any additional role in the study design, data analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘Author contributions’ section.