Background This study examined the association between parenteral energy/amino acid doses and in-hospital mortality among inpatients on long-term nil per os (NPO) status, using a medical claims database in Japan. Methods Hospitalized patients with aspiration pneumonia, aged 65 and older, and on more than 7-day NPO status were identified in a medical claims database between January 2013 and December 2018. Using multivariate logistic regression and regression analyses, we examined the association between mean parenteral energy/amino acid doses and in-hospital mortality, and secondarily, the association between prognosis (in-hospital mortality, inability to receive full oral intake, readmission, and hospital stay length) and 4 groups of mean amino acid doses (no dose: 0 g/kg/day; very low dose: >0, ≤0.3 g/kg/day; low dose: >0.3, ≤0.6 g/kg/day; moderate dose: >0.6 g/kg/day). Results The analysis population included 20 457 inpatients (≥80 years: 78.3%). In total, 5 920 mortalities were recorded. Increased amino acid doses were significantly associated with reduced in-hospital mortality (p < .001). With a no dose reference level, the odds ratios (95% confidence interval) of in-hospital mortality adjusted for potential confounders were 0.78 (0.72–0.85), 0.74 (0.67–0.82), and 0.69 (0.59–0.81) for very low, low, and moderate amino acid doses, respectively. Additionally, patients prescribed amino acid dose levels more than 0.6 g/kg/day had shorter hospitalization periods than those prescribed none. Conclusions Increased amino acid doses were associated with reduced in-hospital mortality. Sufficient amino acid administration is recommended for patients with aspiration pneumonia requiring NPO status.

中文翻译：

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肠外能量或氨基酸剂量对吸入性肺炎患者住院死亡率的影响：一项队列医疗索赔数据库研究

背景 本研究使用日本的医疗索赔数据库，研究了长期无口服 (NPO) 状态的住院患者的肠外能量/氨基酸剂量与住院死亡率之间的关系。方法 在 2013 年 1 月至 2018 年 12 月期间，在医疗索赔数据库中确定了 65 岁及以上且 NPO 状态超过 7 天的住院吸入性肺炎患者。使用多变量逻辑回归和回归分析，我们检查了平均肠外用药之间的关联。能量/氨基酸剂量和住院死亡率，其次是预后（住院死亡率、无法完全经口摄入、再入院和住院时间）与 4 组平均氨基酸剂量（无剂量： 0 g/kg/天；极低剂量：＞0，≤0.3 g/kg/天；低剂量：＞0.3，≤0。6克/公斤/天；中等剂量：＞0.6 g/kg/天）。结果分析人群包括20 457名住院患者（≥80岁：78.3%）。总共记录了 5 920 人死亡。氨基酸剂量增加与住院死亡率降低显着相关（p < .001）。在无剂量参考水平的情况下，针对潜在混杂因素调整的住院死亡率的优势比（95% 置信区间）分别为 0.78（0.72-0.85）、0.74（0.67-0.82）和 0.69（0.59-0.81）（非常低） ，低和中等氨基酸剂量，分别。此外，规定氨基酸剂量水平超过 0.6 g/kg/天的患者住院时间短于未规定的患者。结论 增加氨基酸剂量与降低住院死亡率相关。