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The Impact of Early Protein Advancement in Critically Ill Patients with COVID-19: A Multicenter Cardinality Matching

Abdulrahman Alissa1, Ghazwa B Korayem2, Ohoud Aljuhani3

  • 1Pharmaceutical Care Services, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia.

Therapeutics and Clinical Risk Management
|February 26, 2025
PubMed

Insights

Early high protein intake in critically ill COVID-19 patients did not significantly increase acute kidney injury risk. However, it was linked to a higher incidence of atrial fibrillation, suggesting careful monitoring during nutritional support.

Area of Science:

  • Critical Care Medicine
  • Nutritional Support
  • Infectious Diseases

Background:

  • Limited evidence exists on the safety and effectiveness of early high protein intake in critically ill COVID-19 patients.
  • Assessing the safety of escalating protein during nutritional support is crucial for this population.

Purpose of the Study:

  • To evaluate the safety of early protein advancement in critically ill COVID-19 patients receiving nutritional support.
  • To determine the association between high protein intake and adverse outcomes like acute kidney injury (AKI).

Main Methods:

  • A multi-center retrospective cohort study involving adult COVID-19 patients in Intensive Care Units (ICUs).
  • Patients were stratified into low protein (≤0.8 mg/kg/day) versus high protein (>0.8 mg/kg/day) groups based on intake at day three.
  • Acute kidney injury (AKI) was the primary endpoint; mortality and atrial fibrillation were secondary endpoints.

Main Results:

  • The high protein group (96 patients) showed a lower incidence of AKI compared to the low protein group (192 patients) (12.7% vs 19.9%), but this was not statistically significant.
  • A statistically significant higher rate of atrial fibrillation was observed in the high protein group (OR 2.33; 95% CI 1.18, 4.62; p=0.02).
  • No significant differences in 30-day or in-hospital mortality were found between the groups.

Conclusions:

  • Early protein advancement in critically ill COVID-19 patients was not associated with a significant increase in AKI incidence.
  • Early protein advancement within the first three days of nutritional support was linked to a higher incidence of atrial fibrillation.
  • Further research is needed to optimize protein delivery in this patient cohort.
Abstract

Keywords:
AKICOVID-19SARS-CoV-2acute kidney injurycritically illintensive care unitsmortalitynutritionprotein

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