Nicolo Michele, Heyland Daren K, Chittams Jesse, Sammarco Therese, Compher Charlene
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Department of Medicine, Clinical Evaluation Research Unit, Kingston General Hospital, Ontario, Canada.
JPEN J Parenter Enteral Nutr. 2016 Jan;40(1):45-51. doi: 10.1177/0148607115583675. Epub 2015 Apr 21.
Optimal intake of energy and protein is associated with improved outcomes, although outcomes relative to protein intake are very limited. Our purpose was to evaluate the impact of prescribed protein delivery on mortality and time to discharge alive (TDA) using data from the International Nutrition Survey 2013. We hypothesized that greater protein delivery would be associated with lower mortality and shorter TDA.
The sample included patients in the intensive care unit (ICU) ≥ 4 days (n = 2828) and a subsample in the ICU ≥ 12 days (n = 1584). Models were adjusted for evaluable nutrition days, age, body mass index, sex, admission type, acuity scores, and geographic region. Percentages of prescribed protein and energy intake were compared with mortality outcomes using logistic regression and with Cox proportional hazards for TDA.
Mean intake for the 4-day sample was protein 51 g (60.5% of prescribed) and 1100 kcal (64.1% of prescribed); for the 12-day sample, mean intake was protein 57 g (66.7% of prescribed) and 1200 kcal (70.7% of prescribed). Achieving ≥ 80% of prescribed protein intake was associated with reduced mortality (4-day sample: odds ratio [OR], 0.68; 95% confidence interval [CI], 0.50-0.91; 12-day sample: OR, 0.60; 95% CI, 0.39-0.93), but ≥ 80% of prescribed energy intake was not. TDA was shorter with ≥ 80% prescribed protein (hazard ratio [HR], 1.25; 95% CI, 1.04-1.49) in the 12-day sample but longer with ≥ 80% prescribed energy in the 4-day sample (HR, 0.82; 95% CI, 0.69-0.96).
Achieving at least 80% of prescribed protein intake may be important to survival and shorter TDA in ICU patients. Efforts to achieve prescribed protein intake should be maximized.
能量和蛋白质的最佳摄入量与改善预后相关，尽管与蛋白质摄入量相关的预后数据非常有限。我们的目的是利用2013年国际营养调查的数据，评估规定蛋白质供给量对死亡率和存活出院时间（TDA）的影响。我们假设更高的蛋白质供给量将与更低的死亡率和更短的TDA相关。
样本包括在重症监护病房（ICU）住院≥4天的患者（n = 2828）以及在ICU住院≥12天的子样本（n = 1584）。模型针对可评估的营养天数、年龄、体重指数、性别、入院类型、病情严重程度评分和地理区域进行了调整。使用逻辑回归比较规定蛋白质和能量摄入量的百分比与死亡率结局，并使用Cox比例风险模型分析TDA。
4天样本的平均摄入量为蛋白质51克（占规定量的60.5%）和1100千卡（占规定量的64.1%）；12天样本的平均摄入量为蛋白质57克（占规定量的66.7%）和1200千卡（占规定量的70.7%）。达到规定蛋白质摄入量的≥80%与死亡率降低相关（4天样本：比值比[OR]，0.68；95%置信区间[CI]，0.50 - 0.91；12天样本：OR，0.60；95% CI，0.39 - 0.93），但达到规定能量摄入量的≥80%则不然。在12天样本中，规定蛋白质摄入量≥80%时TDA更短（风险比[HR]，1.25；95% CI，1.04 - 1.49），但在4天样本中，规定能量摄入量≥80%时TDA更长（HR，0.82；95% CI，0.69 - 0.96）。
在ICU患者中，达到规定蛋白质摄入量的至少80%对生存和缩短TDA可能很重要。应最大限度地努力实现规定的蛋白质摄入量。
