Influence of early enteral nutrition on mortality of adult patients with sepsis: a meta-analysis of randomized controlled trials

BACKGROUND: Early enteral nutrition (EEN) has been proposed to improve clinical outcomes in critically ill patients with sepsis. However, the survival benefit of EEN remains uncertain. This meta-analysis aimed to evaluate the effect of EEN on all-cause mortality in adult patients with sepsis. METHODS: A systematic search of PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang was conducted up to May 25, 2025. Randomized controlled trials (RCTs) comparing EEN (initiated within 24-48 h of admission or sepsis diagnosis) vs. non-early enteral nutrition (delayed enteral nutrition or parenteral nutrition) in adult septic patients were included. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model by incorporating the influence of potential heterogeneity. Sensitivity analyses yielded consistent results (OR range: 0.48-0.67; all p < 0.05). Subgroup analyses showed the mortality benefit of EEN was consistent across subgroups defined by sepsis severity (OR: 0.61 vs. 0.56), sepsis diagnostic criteria (Sepsis-1.0/2.0: OR 0.83 vs. Sepsis-3.0: OR 0.51), patient age, sex distribution, EEN initiation time (within 24 vs. 48 h), and mortality follow-up duration (p for subgroup difference all > 0.05). CONCLUSIONS: EEN significantly reduces mortality in adult patients with sepsis. High-quality RCTs are warranted to determine the optimal regimen of EEN in this population.