Abstract
BACKGROUND AND OBJECTIVES: Higher caloric intake may reduce hospital mortality in critically ill patients at high nutritional risk, but the optimal dose for short-term outcomes remains uncertain and evidence on long-term effects is limited. This study evaluated the association between caloric intake and one-year mortality and identified subgroups that may benefit from higher intake. METHODS AND STUDY DESIGN: We conducted a retrospective cohort study in a tertiary medical ICU (2015-2019) including adults receiving mechanical ventilation; ICU stays <48 h were excluded. The exposure was mean caloric intake during ICU days 1-7, defined as total energy from enteral and parenteral routes normalized to body weight. Outcomes included ICU length of stay, ventilator days, and one-year mortality from the Taiwan National Health Insurance Database. Multi-variable Cox models adjusted for age, sex, albumin, hemoglobin, blood glucose, ICU admission etiology, APACHE II score, shock category, mNUTRIC score, renal replacement therapy, and cumulative day-1-7 fluid balance. RESULTS: Among 3,764 patients (mean age 67.1 years; mean Acute Physiology and Chronic Health Evaluation II score 26.5), older age, male sex, lower albumin and hemoglobin, shock requiring multiple vasopressors, greater positive fluid balance, and lower caloric intake were associated with higher one-year mortality. Subgroup analyses showed that patients younger than 65 years, those with an APACHE II score ≥26, and those with refractory shock derived greater benefit from higher caloric intake. CONCLUSIONS: Higher first-week caloric intake was associated with lower one-year mortality, particularly in younger patients, in those with greater illness severity, and in those requiring multiple vasopressors.