Feeding Intolerance in Critically Ill Patients with Enteral Nutrition: A Meta-Analysis and Systematic Review

Figures & Tables

Factors	Egger’s test
Factors	t	P
Age < 2 years old	1.88	0.209
Age > 60 years old	2.47	0.113
APACHE II score ≥ 20	1.14	0.265
Hyperglycemia	−1.32	0.179
Hypokalemia	5.30	0.013
Hypoproteinemia	−0.56	0.612
Starting time of enteral nutrition > 72 hours	−1.88	0.312
No dietary fiber	1.89	0.131
Intra-abdominal pressure > 15mmhg	1.18	0.965
Central venous pressure > 10cmh₂o	3.54	0.971
Mechanical ventilation	2.08	0.331
Use of sedatives	−0.22	0.832
Use of vasoactive drugs	−0.14	0.910
Use of acidogenic agents	10.58	0.060
Blood purification	−0.16	0.572

Study	Design	Sample size	Case/control	Incidence of feeding intolerance	Influencing factors
Bejarano 2012	Cohort study	82	21/51	29.17%	2, 6, 12
Chen 2017	Case control study	92	54/38	58.69%	2, 4, 6, 7, 8, 9, 11, 12, 13
Cai 2018	Case control study	373	155/218	41.55%	1, 3, 7, 8, 10, 12, 13, 14
Sun 2018	Case control study	295	121/174	41.02%	3, 6, 9, 10, 12, 15, 16
Liu 2018	Case control study	86	52/34	60.47%	3, 4, 5, 7, 10, 13
Jin 2018	Case control study	243	84/159	34.57%	1, 3, 6, 7, 8, 9, 10, 11, 12, 13, 15
Wang 2019	Case control study	118	49/69	41.53%	3, 4, 5, 9, 11
Zhou 2019	Case control study	84	33/51	39.29%	3, 4, 6, 9, 11, 13, 16
Liu 2020	Case control study	200	115/85	57.50%	1, 7, 9, 10
Deng 2020	Case control study	120	68/52	56.67%	3, 12, 13
Zhai 2020	Case control study	91	49/42	53.85%	3, 4, 5, 6, 9, 10, 12, 13, 14
Li 2019	Case control study	568	184/384	32.39%	3, 6, 16
Mentec 2001	Cohort study	153	59/94	38.56%	3, 4, 5, 13, 15
Gungabissoon 2014	Cohort study	1888	576/1312	30.51%	4, 6, 9
Li 2021	Case control study	70	29/41	41.43%	1, 4, 5, 6, 10
Geng 2022	Case control study	884	352/532	39.82%	1, 6, 7, 9, 12
Zhang 2022	Cohort study	83	36/47	43.37%	2, 4, 5, 8, 10, 13
Zheng 2021	Case control study	134	56/78	41.79%	2, 5, 7, 9

Factors	Number of synthesized studies	Heterogeneity		Model	Synthesized effects
		I²(%)	P		OR	95%CI	P
Age < 2 years old	2	16	0.44	Fixed	1.84	1.32~2.05	0.015
Age > 60 years old	4	0	0.75	Fixed	2.04	1.45~2.61	0.007
APACHE II score ≥ 20	6	11	0.18	Fixed	3.18	2.95~3.89	0.033
Hyperglycemia	4	59	0.03	Random	1.70	0.88~2.46	0.069
Hypokalemia	5	47	0.11	Fixed	1.59	1.24~2.03	<0.001
Hypoproteinemia	5	89	<0.01	Random	0.70	0.26~1.90	0.486
Starting time of enteral nutrition > 72 hours	3	0	0.87	Fixed	2.24	1.49~3.36	<0.001
No dietary fiber	8	68	0.01	Random	3.72	2.23~6.19	<0.001
Intra-abdominal pressure > 15mmhg	7	0	0.51	Fixed	2.95	2.10~3.85	<0.001
Central venous pressure > 10cmh₂o	4	45	0.15	Fixed	1.96	1.47~2.62	<0.001
Mechanical ventilation	9	44	0.23	Fixed	1.37	1.19~1.89	0.012
Use of sedatives	7	74	<0.01	Random	1.19	0.93~1.53	0.161
Use of vasoactive drugs	3	89	<0.01	Random	0.95	0.56~1.61	0.854
Use of acidogenic agents	3	0	0.41	Fixed	0.84	0.52~1.38	0.506
Blood purification	4	97	<0.01	Random	1.41	0.86~2.30	0.171

Study	Patient selection	Comparability	Exposure assessment	NOS total score
Bejarano 2012	3	2	2	7
Chen 2017	3	2	2	7
Cai 2018	3	2	2	7
Sun 2018	3	2	3	8
Liu 2018	3	2	2	7
Jin 2018	3	2	2	7
Wang 2019	3	2	3	8
Zhou 2019	3	2	2	7
Liu 2020	3	2	2	7
Deng 2020	3	1	3	7
Zhai 2020	3	2	2	7
Li 2019	3	2	3	8
Mentec 2001	3	2	2	7
Gungabissoon 2014	3	2	2	7
Li 2021	3	2	3	8
Geng 2022	3	2	3	8
Zhang 2022	3	2	3	8
Zheng 2021	3	2	2	7