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Published on: September 20, 2019
Impact of early high protein intake in critically ill patients: a randomized controlled trial
Yifei Wang1, Yanyang Ye1, Lusha Xuan1
1Intensive Care Unit, Zhuji Traditional Chinese Medical Hospital, Zhuji, 311800, Zhejiang, China.
Insights
Higher early protein intake (1.5 g/kg/d) in critically ill patients improved nutritional status and prognosis, reducing mortality and ICU stay. This approach appears safe and beneficial for recovery.
Area of Science:
- Critical Care Medicine
- Clinical Nutrition
- Intensive Care Unit Management
Background:
- Conflicting evidence exists on the impact of high protein intake in early-phase critically ill patients.
- Assessing higher early protein intake's effect on prognosis is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the influence of increased early protein supplementation on the prognosis of critically ill patients.
- To determine if higher protein intake improves outcomes such as mortality and length of stay.
Main Methods:
- A randomized controlled trial involving 173 critically ill patients requiring at least 7 days in the Intensive Care Unit/Emergency ICU (ICU/EICU).
- Patients received either 0.8 g/kg/d (Low group, n=87) or 1.5 g/kg/d (High group, n=86) of protein within 1-3 days of enteral nutrition (EN) initiation, both groups transitioning to 1.5 g/kg/d by day 4.
- Key parameters including serum prealbumin (PA), blood urea nitrogen/creatinine ratio, and rectus femoris muscle dimensions were monitored throughout the ICU/EICU stay.
Main Results:
- No significant baseline differences were observed between the Low and High protein groups.
- The High protein group showed a significantly lower 28-day mortality rate (HR=2.462) compared to the Low group.
- Patients receiving higher protein intake experienced shorter mechanical ventilation durations, reduced ICU stays, improved serum PA levels, and less muscle atrophy.
Conclusions:
- Increasing early protein intake to 1.5 g/kg/d is safe for critically ill patients.
- Higher early protein intake can enhance nutritional status and improve patient prognosis.
- This strategy may be beneficial for reducing mortality and length of ICU stay in critically ill populations.
Background:
Conflicting findings regarding the impact of High protein intake during the early phase in critically ill patients have been reported. Therefore, we aimed to assess the influence of higher early protein intake on the prognosis of critically ill patients.
Methods:
This randomized controlled trial involved 173 critically ill patients who stayed in the Intensive Care Unit/Emergency ICU (ICU/EICU) for at least 7 days. The Low group (n = 87) and High group (n = 86) received protein supplementation of 0.8 g/kg.d and 1.5 g/kg.d, respectively, within 1-3 days of enteral nutrition (EN) initiation, with both groups transitioning to 1.5 g/kg.d on the 4th day. The serum prealbumin (PA), blood urea nitrogen/creatinine, and rectus femoris muscle thickness and cross-sectional area of all patients was measured on the 1th, 3rd, 5th, 7th day, and the day of ICU/EICU discharge.
Results:
Patients in both Low and High groups showed no significant differences in age, APACHE II scores, or other demographic and baseline characteristics. There were also no significant differences in the primary outcome (28-day mortality rate) and secondary outcomes (incidence rate of refeeding syndrome and EN tolerance score) between the two groups. However, the Low group exhibited a significantly higher 28-day mortality rate (HR = 2.462, 95% CI: 1.021-5.936, P = 0.045) compared to High group, as determined by Cox proportional hazards models incorporating the time factor. The High group exhibited significantly shorter durations of mechanical ventilation and ICU stay compared to the Low group. Serum PA levels were higher, and rectus femoris muscle atrophy rates were lower in the High group. Furthermore, for septic patients, high protein intake significantly reduced the 28-day mortality rate despite a small sample size (n = 34).
Conclusions:
Our study indicates that increasing early protein intake to 1.5 g/kg.d may be safe and help improve the nutritional status and prognosis of critically ill patients.
Trial Registration:
This study was registered with the Chinese Clinical Trial Registry (ChiCTR2000039997, https://www.chictr.org.cn/ ).
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