Trial reportCritical care (London, England)2012
Early versus late parenteral nutrition in ICU patients: cost analysis of the EPaNIC trial.
Trial report in Critical care (London, England), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00512122 (Impact of Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients), which is not on this map. Cited by 24 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Impact of Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients
Who cites it
24 citing papers in PubMed, 2 syntheses or guidelines pooled it, 66 citations in OpenAlex.
- Nutrition support for acute kidney injury 2020-consensus of the Taiwan AKI task force.Journal of the Chinese Medical Association : JCMA · 2022Pooled it
- Nutrition support in hospitalised adults at nutritional risk.The Cochrane database of systematic reviews · 2017Pooled it
- Impact of withholding early parenteral nutrition on 2-year mortality and functional outcome in critically ill adults.Intensive care medicine · 2024Trial
- Trial
- Association of Baseline Inflammation With Effectiveness of Nutritional Support Among Patients With Disease-Related Malnutrition: A Secondary Analysis of a Randomized Clinical Trial.JAMA network open · 2020Trial
- The soluble mannose receptor (sMR/sCD206) in critically ill patients with invasive fungal infections, bacterial infections or non-infectious inflammation: a secondary analysis of the EPaNIC RCT.Critical care (London, England) · 2019Trial
- Cost-effectiveness study of early versus late parenteral nutrition in critically ill children (PEPaNIC): preplanned secondary analysis of a multicentre randomised controlled trial.Critical care (London, England) · 2018Trial
- Trial
- Hypocaloric compared with eucaloric nutritional support and its effect on infection rates in a surgical intensive care unit: a randomized controlled trial.The American journal of clinical nutrition · 2014Trial
- LOGIC-insulin algorithm-guided versus nurse-directed blood glucose control during critical illness: the LOGIC-1 single-center, randomized, controlled clinical trial.Diabetes care · 2013Trial
- Timing of Parenteral Nutrition in Neonates, Infants, and Children: Current Evidence, Circadian Considerations, and Emerging Directions.Nutrients · 2026Review
- Precision nutrition in critical illness: a phase-specific framework from acute feeding to post-ICU recovery.Frontiers in nutrition · 2026Review
- Association of phenylalanine and tyrosine metabolism with mortality and response to nutritional support among patients at nutritional risk: a secondary analysis of the randomized clinical trial EFFORT.Frontiers in nutrition · 2024Article
- Association of tryptophan pathway metabolites with mortality and effectiveness of nutritional support among patients at nutritional risk: secondary analysis of a randomized clinical trial.Frontiers in nutrition · 2024Article
- Nutritional status of patients with COVID-19 1-y post-ICU stay: A prospective observational study.Nutrition (Burbank, Los Angeles County, Calif.) · 2023Observational
- Article
- Early versus later initiation of parenteral nutrition for very preterm infants: a propensity score-matched observational study.Archives of disease in childhood. Fetal and neonatal edition · 2022Observational
- Medical Nutrition Therapy in Critically Ill Patients Treated on Intensive and Intermediate Care Units: A Literature Review.Journal of clinical medicine · 2019Review
- Paediatric endocrinology: Tight glycaemic control in critically ill children.Nature reviews. Endocrinology · 2014Article
- Timing of (supplemental) parenteral nutrition in critically ill patients: a systematic review.Annals of intensive care · 2014Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
15 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe EPaNIC randomized controlled multicentre trial showed that postponing initiation of parenteral nutrition (PN) in ICU-patients to beyond the first week (Late-PN) enhanced recovery, as compared with Early-PN. This was mediated by fewer infections, accelerated recovery from organ failure and reduced duration of hospitalization. Now, the trial's preplanned cost analysis (N = 4640) from the Belgian healthcare payers' perspective is reported.
methodsCost data were retrieved from individual patient invoices. Undiscounted total healthcare costs were calculated for the index hospital stay. A cost tree based on acquisition of new infections and on prolonged length-of-stay was constructed. Contribution of 8 cost categories to total hospitalization costs was analyzed. The origin of drug costs was clarified in detail through the Anatomical Therapeutic Chemical (ATC) classification system. The potential impact of Early-PN on total hospitalization costs in other healthcare systems was explored in a sensitivity analysis.
resultsICU-patients developing new infection (24.4%) were responsible for 42.7% of total costs, while ICU-patients staying beyond one week (24.3%) accounted for 43.3% of total costs. Pharmacy-related costs represented 30% of total hospitalization costs and were increased by Early-PN (+608.00 EUR/patient, p = 0.01). Notably, costs for ATC-J (anti-infective agents) (+227.00 EUR/patient, p = 0.02) and ATC-B (comprising PN) (+220.00 EUR/patient, p = 0.006) drugs were increased by Early-PN. Sensitivity analysis revealed a mean total cost increase of 1,210.00 EUR/patient (p = 0.02) by Early-PN, when incorporating the full PN costs.
conclusionsThe increased costs by Early-PN were mainly pharmacy-related and explained by higher expenditures for PN and anti-infective agents. The use of Early-PN in critically ill patients can thus not be recommended for both clinical (no benefit) and cost-related reasons.
trial registrationClinicalTrials.gov NCT00512122.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.