PD218 - METABOLIC TRANSITION–ALIGNED TIMING OF TOTAL PARENTERAL NUTRITION AND POST-INFUSION LIPEMIA IN CRITICAL ILLNESS

PD218

METABOLIC TRANSITION–ALIGNED TIMING OF TOTAL PARENTERAL NUTRITION AND POST-INFUSION LIPEMIA IN CRITICAL ILLNESS

D. Stein^1,*, Y. gargi²

¹sheba, ramat gan, Israel, ²icu, sheba, ramat gan, Israel

Rationale: Stress-induced insulin resistance and inflammatory dyslipidemia may impair handling of exogenous lipid delivery during critical illness. We evaluated whether total parenteral nutrition (TPN) administered before versus after a physiology-based metabolic transition differed in its association with routine post-infusion lipemia, and whether transition-relative timing was more informative than ICU calendar day alone.

Methods:  We performed a retrospective transition-aligned analysis of adult ICU patients with linked TPN episodes, routine daily lipemia measurements from the standard SMAC chemistry panel, and sufficient glucose and insulin-infusion data for transition timestamp calculation. Transition timestamps were recalculated in the current dataset using the published physiology-based model combining a steroid-corrected daily insulin resistance index with concordant recovery signals

Results: The dataset included 722 patients, 6,884 TPN episodes, and 1,198 qualifying windows within ±72 hours of transition; 454 qualifying windows had a routine post-window lipemia result available for sampled window-level analyses. The prespecified primary same-day cohort comprised 218 patient-days from 160 patients. In the primary same-day analysis, post-transition TPN was associated with lower odds of any lipemia than pre-transition TPN occurring on the same ICU day (adjusted OR 0.37, 95% CI 0.16-0.86; P=0.020). Transition-relative timing showed a stronger and more consistent association with lipemia risk than ICU calendar day alone, and a matched event-anchored analysis showed similar directional support (OR 0.25, 95% CI 0.09-0.69; P=0.007). 

Conclusion: In this transition-aligned ICU cohort, post-transition TPN was associated with lower routine post-infusion lipemia than pre-transition TPN, particularly in analyses that tightly aligned exposure timing with transition and lipemia measurement.

Disclosure of Interest: None declared