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Visceral protein response to enteral versus parenteral nutrition and sepsis in patients with trauma.

BACKGROUND
Sepsis and the route of nutrient administration are clearly related to visceral protein levels; however, the mechanisms and amount of influence are not completely defined.


METHODS
Constitutive and acute-phase protein levels were measured on days 1, 4, 7, and 10 in 68 severely injured patients with abdominal trauma indexes of 15 or more randomized to enteral or parenteral feeding. Groups were matched for age, abdominal trauma index, injury severity score, and length of stay.


RESULTS
Significantly higher levels of constitutive proteins and lower levels of acute-phase proteins were found in patients randomized to enteral feeding. Although some "hepatic protein reprioritization" appeared to be caused by nutrient route, this appeared only in the less severely injured patients. A more important factor in visceral protein levels is a reduction in septic morbidity associated with enteral feeding.


CONCLUSIONS
Enteral feeding produces greater increase in constitutive proteins and greater decreases in acute-phase proteins after severe trauma primarily caused by reduced septic morbidity with enteral feeding.