Development of a prediction model for enteral feeding intolerance in intensive care unit patients: A prospective cohort study

Table 1 Baseline characteristics of the participants included in the analysis

Variables	EFI group, n = 77	Non-EFI group, n = 126	Statistics	P value
Age in yr	64.55 ± 15.86	69.06 ± 14.31	t = 2.091	0.038
Sex, n (%)			χ2 = 1.919	0.166
Male	55 (71.4)	78 (61.9)
Female	22 (28.6)	48 (38.1)
BMI in kg/m2	23.64 ± 3.41	23.91 ± 4.70	t = 0.030	0.672
APACHE Ⅱ	15.0 (9.0, 23.0)	15.0 (9.5, 21.0)	Z = -0.117	0.907
SOFA	6.0 (3.0, 10.0)	5.0 (1.0, 8.0)	Z = -1.533	0.125
Diagnosis, n (%)			χ2 = 1.574	0.986
Respiratory disease	15 (19.5)	26 (20.6)
Circulatory disease	6 (7.8)	9 (7.1)
Neurological disease	12 (15.6)	25 (19.8)
Digestive disease	11 (14.3)	18 (14.3)
Post-surgery	22 (28.6)	30 (23.8)
Sepsis	5 (6.5)	7 (5.6)
Multiple trauma	3 (3.9)	4 (3.2)
Other	3 (3.9)	7 (5.6)
Endpoint event, n (%)
Diagnosis of EFI	77 (100)
EN for more than 2 wk		35 (27.8)
Transfer out of the ICU		65 (51.6)
Gastric tube removal		18 (14.3)
Death		8 (6.3)

APACHE Ⅱ: Acute physiology and chronic health evaluation II; BMI: Body mass index; EFI: Enteral feeding intolerance; EN: Enteral nutrition; ICU: Intensive care unit; SOFA: Sepsis-related organ failure assessment.

Table 2 Enteral feeding intolerance occurrence in the case group, n (%)

Variables	Case group, n = 77
EN tube
Nasogastric	72 (93.5)
Nasal jejunal	3 (3.9)
Jejunostomy	2 (2.6)
When EFI occurred after EN started
1-3 d	20 (26.0)
4-7 d	32 (41.6)
8-14 d	25 (32.5)
Number of days EFI lasted
1 d	46 (59.7)
2-3 d	28 (36.4)
≥ 4 d	3 (3.9)
GI symptoms
Diarrhea	31 (40.3)
Abdominal distention	22 (28.6)
Regurgitation	14 (18.2)
Vomiting	5 (6.5)
Aspiration	2 (2.6)
Large GRV	2 (2.6)
Constipation	1 (1.3)

EFI: Enteral feeding intolerance; EN: Enteral nutrition; GI: Gastrointestinal; GRV: Gastric residual volume.

Table 3 Univariate analysis of predictors associated with enteral feeding intolerance

Variables	EFI group, n = 77	Non-EFI group, n = 126	Statistics	P value
Age in yr, mean ± SD	64.55 ± 15.86	69.06 ± 14.31	t = 2.091	0.038
Sex, n (%)			χ2 = 1.919	0.166
Male	55 (71.4)	78 (61.9)
Female	22 (28.6)	48 (38.1)
Diabetes, n (%)	20 (26.0)	33 (26.2)	χ2 = 0.001	0.973
Abdominal surgery, n (%)	9 (11.7)	21 (16.7)	χ2 = 0.941	0.332
GI disease, n (%)	15 (19.5)	37 (29.4)	χ2 = 2.451	0.117
Head injury, n (%)	14 (18.2)	18 (14.3)	χ2 = 0.546	0.460
Sepsis, n (%)	5 (6.5)	12 (9.5)	χ2 = 0.572	0.449
Trauma, n (%)	3 (3.9)	8 (6.3)		0.539
Analgesic, n (%)	33 (42.9)	49 (38.9)	χ2 = 0.313	0.576
Sedative, n (%)	49 (63.6)	58 (46.0)	χ2 = 5.942	0.015
Catecholamines, n (%)	22 (28.6)	26 (20.6)	χ2 = 1.667	0.197
Early feeding, n (%)	42 (54.5)	88 (69.8)	χ2 = 4.856	0.028
Feeding volume in mL	1000 (500, 1500)	1000 (500, 1400)	Z = -0.495	0.620
Feeding speed in mL/h	80 (50, 100)	80 (50, 100)	Z = -0.220	0.826
Mechanical ventilation, n (%)
Before EN started	54 (70.1)	60 (47.6)	χ2 = 9.837	0.002
When EN started	54 (70.1)	64 (50.8)	χ2 = 7.342	0.007
Abnormal level of albumin, n (%)
Diagnosis with hypoproteinemia	1 (1.3)	4 (3.2)		0.652
Albumin before EN	14 (18.2)	21 (16.7)	χ2 = 0.077	0.782
Albumin when EN started	1 (1.3)	6 (4.8)		0.257
Abnormal level of electrolytes, n (%)
Diagnosis with electrolyte disorders	5 (6.5)	12 (9.5)	χ2 = 0.572	0.449
Before EN started, n (%)
Potassium	32 (41.6)	45 (35.7)	χ2 = 0.693	0.405
Sodium	38 (49.4)	49 (38.9)	χ2 = 2.136	0.144
Chlorine	54 (70.1)	88 (69.8)	χ2 = 0.002	0.965
Magnesium	53 (68.8)	81 (64.3)	χ2 = 0.440	0.507
Calcium	69 (89.6)	118 (93.7)	χ2 = 1.075	0.300
Phosphorus	55 (71.4)	77 (61.1)	χ2 = 2.237	0.135
When EN started, n (%)
Potassium	14 (18.2)	22 (17.5)	χ2 = 0.017	0.896
Sodium	32 (41.6)	33 (26.2)	χ2 = 5.186	0.023
Chlorine	55 (71.4)	76 (60.3)	χ2 = 2.578	0.108
Magnesium	38 (49.4)	59 (46.8)	χ2 = 0.122	0.727
Calcium	69 (89.6)	113 (89.7)	χ2 = 0.000	0.987
Phosphorus	43 (55.8)	63 (50.0)	χ2 = 0.654	0.419
Feeding formula, n (%)			χ2 = 10.861	0.048
Rice soup	10 (13.0)	5 (4.0)
Peptisorb	14 (18.2)	39 (31.0)
Nutrison Fibre	15 (19.5)	33 (26.2)
TPF-D1	24 (31.2)	32 (25.4)
TPF-T2	3 (3.9)	2 (1.6)
Water	11 (14.3)	15 (11.9)

¹TPF-D: Enteral Nutritional Emulsion “RuiDai,” suitable for diabetics.

²TPF-T: Enteral Nutritional Emulsion “RuiNeng”, rich in fat and calorie.

EN: Enteral nutrition; EFI: Enteral feeding intolerance; GI: Gastrointestinal.

Table 4 Final clinical prediction model of enteral feeding intolerance in the intensive care unit

Variable	OR (95%CI)	Z statistic	P value
Age in yr	0.98 (0.96, 1.00)	-1.881	0.060
GI disease	0.41 (0.18, 0.86)	-2.254	0.024
Early feeding	0.56 (0.28, 1.11)	-1.652	0.099
MV before EN	2.39 (1.27, 4.58)	2.682	0.007
Abnormal Na+ when EN started	2.11 (1.11, 4.07)	2.262	0.024

EN: Enteral nutrition; GI: Gastrointestinal; MV: Mechanical ventilation; OR: Odds ratio.