ArticleBMJ open2026
Early versus delayed enteral nutrition in patients with sepsis: a propensity score-matched cohort study at a tertiary hospital in Hebei, China.
Article in BMJ open, 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
objectivesEnteral nutrition (EN) constitutes a critical therapeutic intervention in the management of patients with sepsis; however, the optimal timing for its initiation remains uncertain. This study sought to evaluate the impact of early versus delayed EN on mortality rates and clinical outcomes among adult patients with sepsis in intensive care units (ICU).
designRetrospective cohort study using propensity score matching (PSM) methodology.
settingA tertiary hospital ICU in Hebei Province, China, from 2015 to 2024.
participantsThis retrospective analysis involved adult ICU patients with sepsis (meeting Sepsis 3.0 criteria) from January 2015 to December 2024 who began EN within 7 days of admission. Patients were classified into early (within 2 days) or delayed (2-7 days) EN groups based on when nutrition was initiated. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were 28-day and 60-day mortality, with secondary outcomes including hospital/ICU stay length, mechanical ventilation duration and nutrition-related complications.
resultsA study of 2205 patients compared early EN (EEN) in 1500 patients (68.0%) with delayed EN in 705 patients (32.0%). After PSM, the EEN group showed a higher mortality risk at 28 days (HR 1.44, 95% CI 1.08 to 1.92) and 60 days (HR 1.45, 95% CI 1.11 to 1.89), confirmed by multivariable Cox regression and inverse probability weighting. EEN patients also had more gastric retention (OR 1.77, 95% CI 1.14 to 2.79). The increased mortality risk was notably pronounced in younger male patients with a body mass index of less than 24 kg/m², abdominal infections, those with severe sepsis and patients necessitating vasopressor support at a norepinephrine equivalent of ≥0.1 µg/kg/min. Sensitivity analyses supported these findings.
conclusionsOur retrospective analysis of 2205 propensity score-matched patients with sepsis found that EEN is linked to higher short-term mortality, especially in younger males, those with severe illness, abdominal infections or needing moderate to high vasopressor support. This suggests that personalised nutritional timing might be better than universal early feeding. However, these findings are preliminary and need confirmation through randomised controlled trials.
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