Associations between nurses’ nutrition knowledge, attitudes, and practices and systemic inflammatory response, feeding tolerance, and clinical prognosis in critically Ill patients– a prospective observational cohort study in intensive care units

To explore associations between ICU nurses’ nutrition knowledge‑attitudes‑practices (KAP) and dynamic procalcitonin (PCT) levels as well as clinical outcomes in critically ill patients with enteral nutrition (EN) intolerance. A prospective observational cohort study was conducted. A total of 200 ICU patients receiving enteral nutrition support were enrolled. Participants were divided into a high‑KAP group and a low‑KAP group based on total nutrition KAP scores of their responsible nurses. The primary endpoint was longitudinal serum PCT trajectories; secondary indicators included the incidence of EN intolerance, ICU length of stay, mechanical ventilation duration and 28‑day all‑cause mortality. Categorical and continuous variables were compared using the χ² test and independent‑samples t‑test, respectively. A linear mixed‑effects model was applied to analyse longitudinal changes in serum PCT levels. Multivariable regression was used to estimate adjusted effect estimates with 95% confidence intervals (CIs) for principal outcomes, with adjustment for age, sex and admission APACHE II score. The crude incidence of EN intolerance was 21% in the high‑KAP group versus 45% in the low‑KAP group. After multivariable adjustment, higher nurse KAP was independently associated with lower risk of EN intolerance (adjusted OR = 0.57, 95% CI 0.32‑0.98). According to estimated marginal means derived from the linear mixed‑effects model, serum PCT exhibited a more favourable declining trajectory in the high‑KAP group after EN initiation, with lower values at EN day 3 (1.12 ± 0.53 µg/L vs. 1.65 ± 0.62 µg/L) and day 7 (0.76 ± 0.41 µg/L vs. 1.24 ± 0.58 µg/L). Higher nurse KAP was also independently associated with shorter ICU length of stay (adjusted β = −1.38, 95% CI − 2.67‑−0.09) and shorter mechanical‑ventilation duration (adjusted β = −1.12, 95% CI − 2.21‑−0.03). The crude 28‑day all‑cause mortality was 9.0% in the high‑KAP group compared with 21.0% in the low‑KAP group. Higher nutrition‑related KAP competency among ICU nurses was associated with lower risk of EN intolerance, a more favourable serum PCT trajectory, and more favourable short‑term clinical outcomes among critically ill patients. Observations from six participating ICUs in Shandong Province indicate that targeted training focused on nurses’ nutrition‑related KAP merits further evaluation.