The higher C-reactive protein (CRP) rise with late parenteral nutrition (PN), explained by the early macronutrient deficits, did not relate to cytokine responses and thus did not reflect more systemic inflammation. Instead of mediating clinical benefit on infection or recovery, the accentuated CRP rise appeared an adverse effect reducing such late-PN benefits.

CRP peaked on day 3, higher with late-PN than with early-PN.

Independent determinants of higher CRP rise were lower carbohydrate and protein intakes (p ≤ 0.04) with late-PN, besides higher blood glucose and serum insulin concentrations (p ≤ 0.01).

Late-PN did not affect cytokines.

This secondary analysis of the EPaNIC-RCT first investigated, with multivariable linear regression analyses, determinants of late-PN-induced CRP rise and its association with cytokine responses in matched early-PN and late-PN patients requiring intensive care for ≥ 3 days.

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