ArticleFrontiers in medicine2026
Early supplemental parenteral nutrition and risk of subsequent enteroatmospheric fistula in high-risk open abdomen patients with persistent enteral nutrition intolerance: a landmark propensity score-matched cohort study.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: High-risk open abdomen (OA) patients with acute gastrointestinal injury (AGI) and persistent enteral nutrition (EN) intolerance are particularly vulnerable to cumulative energy-protein deficit, yet the optimal timing of supplemental parenteral nutrition (SPN) remains uncertain. We evaluated whether earlier SPN initiation was associated with a lower subsequent incidence of enteroatmospheric fistula (EAF) in this population. Methods: We conducted a single-center retrospective cohort study of adult OA patients admitted to the intensive care unit between January 2019 and December 2024 who had AGI grade II-III, persistent EN intolerance by ICU Day 3, and a modified Nutrition Risk in the Critically Ill score of at least 5. Using ICU Day 7 as the landmark time point, patients who initiated SPN between ICU Days 3 and 7 were classified as the early-SPN group, and those who initiated SPN after ICU Day 7 as the late-SPN group. Patients who never received SPN were intentionally excluded to focus the analysis on the optimal timing among those who definitively required supplementation. One-to-one propensity score matching was performed. The primary outcome was EAF occurring after ICU Day 7. Results: Among 355 screened patients, 284 met the eligibility criteria, including 110 early-SPN and 174 late-SPN patients; 102 matched pairs were analyzed. During ICU Days 3-7, the early-SPN group received higher energy and protein delivery. EAF occurred in 13/102 patients (12.75%) in the early-SPN group and 31/102 (30.39%) in the late-SPN group (relative risk, 0.42; 95% CI, 0.23-0.75; Conclusion: Among high-risk OA patients with AGI and persistent EN intolerance who subsequently required SPN, initiation of SPN between ICU Days 3 and 7 was associated with improved short-term nutritional delivery, shorter mechanical ventilation duration, and a lower subsequent incidence of EAF than later SPN initiation.
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