Detecting the metabolic transition to personalize nutritional timing: model development and preliminary validation in a large ICU cohort
Authors' conclusion
We developed and validated a physiological model for detecting metabolic transition in critical illness and showed that transition occurs early and strongly predicts survival. Higher caloric delivery before transition is associated with increased mortality
Study context
- Population
- Critically ill patients in a tertiary-care general ICU (age 59.8 ± 16.5 years; SOFA 11.7 ± 3.9; 82% mechanically ventilated)
- Participants
- 2,350 patients
- Exposure
- Metabolic transition by ICU day 3 vs later or no transition
- Outcome
- 90-day mortality
- Follow-up
- 90 days
Methodological detailssingle-centre, tertiary-care general ICU, model development and preliminary validation, landmark Cox models
- Single-centre
- Tertiary-care general ICU
- Model development and preliminary validation
- Landmark Cox models
Main finding
As reported in the abstract
Metabolic transition (≥ 30% sustained drop in insulin resistance index after peak plus ≥ 2 of 8 physiologic recovery criteria)
Metabolic transition identified
94%
Transitioned by ICU day 3
≈60%
Transition by day 3 associated with lower 90-day mortality, HR
0.72
95% CI 0.65–0.81
Observational data: associations, not effects.
Further findings
90-day mortality with high caloric delivery (≥ 1.0 kcal/kg/h for ≥ 24 h) before transition
| OR (95% CI) | ||
|---|---|---|
| High caloric delivery before transitionIndependently associated; dose-response pattern | 1.25 (1.01–1.55) | |
| 0.512Odds ratio (log scale) |
- High caloric delivery based on calendar timing failed to demonstrate a similar pattern
Original publication
Detecting the metabolic transition to personalize nutritional timing: model development and preliminary validation in a large ICU cohort. Crit Care. Published 24 February 2026. doi:10.
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