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Early Administration of Protein in Critically Ill Patients: A Retrospective Cohort Study
Itai Bendavid1,2, Oren Zusman3,4, Ilya Kagan5,6
1Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, 49100 Petah Tikva, Israel. itbd@walla.com.
Insights
Early protein administration in critically ill patients is linked to better survival rates. This study found that providing adequate protein within the first three days improved outcomes for intensive care unit (ICU) patients.
Area of Science:
- Critical Care Medicine
- Nutritional Science
- Clinical Research
Background:
- Optimal protein intake timing for critically ill patients remains unclear.
- Early nutritional support is crucial for recovery in intensive care unit (ICU) settings.
Purpose of the Study:
- To investigate the association between early protein administration and mortality rates in mixed ICU patients.
- To compare outcomes of early versus late protein delivery in critical care.
Main Methods:
- Retrospective cohort study of 2253 mixed ICU patients.
- Classified patients into early protein group (>0.7 g/kg/d within 3 days) and late protein groups (low or high intake after 3 days).
- Analyzed all-cause mortality at 60 days using multivariable Cox regression.
Main Results:
- Early protein group showed significantly lower mortality (36%) compared to the late-high group (43%) (p < 0.001).
- Early protein administration was associated with increased survival (HR 0.83, 95% CI 0.71⁻0.97, p = 0.017) after adjusting for confounders.
- The late-low group also had higher mortality than the early group (data not explicitly stated but implied by comparison).
Conclusions:
- Early protein administration in critically ill patients is associated with improved survival.
- Timely nutritional support, specifically protein delivery, may be a key factor in critical care outcomes.
- Further prospective studies are warranted to confirm these findings.
Abstract:
It is currently uncertain whether early administration of protein improves patient outcomes. We examined mortality rates of critically ill patients receiving early compared to late protein administration. This was a retrospective cohort study of mixed ICU patients receiving enteral or parenteral nutritional support. Patients receiving >0.7 g/kg/d protein within the first 3 days were considered the early protein group and those receiving less were considered the late protein group. The latter were subdivided into late-low group (LL) who received a low protein intake (<0.7 g/kg/d) throughout their stay and the late-high group (LH) who received higher doses (>0.7 g/kg/d) of protein following their first 3 days of admission. The outcome measure was all-cause mortality 60 days after admission. Of the 2253 patients included in the study, 371 (36%) in the early group, and 517 (43%) in the late-high group had died (p < 0.001 for difference). In multivariable Cox regression analysis, while controlling for confounders, early protein administration was associated with increased survival (HR 0.83, 95% CI 0.71⁻0.97, p = 0.017). Administration of protein early in the course of critical illness appears to be associated with improved survival in a mixed ICU population, even after adjusting for confounding variables.
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