Department of Intensive Care Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands.
Department of Information Technology and Datawarehouse, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands.
Clin Nutr. 2019 Apr;38(2):883-890. doi: 10.1016/j.clnu.2018.02.012. Epub 2018 Feb 17.
BACKGROUND & AIMS: Optimal protein intake during critical illness is unknown. Conflicting results on nutritional support during the first week of ICU stay have been published. We addressed timing of protein intake and outcomes in ICU patients requiring prolonged mechanical ventilation.
We retrospectively collected nutritional and clinical data on the first 7 days of ICU admission of adult critically ill patients, who were mechanically ventilated in our ICU for at least 7 days and admitted between January 1st 2011 and December 31st 2015. Based on recent literature, patients were divided into 3 protein intake categories, <0.8 g/kg/day, 0.8-1.2 g/kg/day and >1.2 g/kg/day. Our primary aim was to identify the optimum protein dose and timing related to the lowest 6 month mortality. Secondary endpoints were ventilation duration, need for renal replacement therapy (RRT), ICU length of stay (LOS) and mortality and hospital LOS and mortality.
In total 455 patients met the inclusion criteria. We found a time-dependent association of protein intake and mortality; low protein intake (<0.8 g/kg/day) before day 3 and high protein intake (>0.8 g/kg/day) after day 3 was associated with lower 6-month mortality, adjusted HR 0.609; 95% CI 0.480-0.772, p < 0.001) compared to patients with overall high protein intake. Lowest 6-month mortality was found when increasing protein intake from <0.8 g/kg/day on day 1-2 to 0.8-1.2 g/kg/day on day 3-5 and >1.2 g/kg/day after day 5. Moreover, overall low protein intake was associated with the highest ICU, in-hospital and 6-month mortality. No differences in ICU LOS, need for RRT or ventilation duration were found.
Our data suggest that although overall low protein intake is associated with the highest mortality risk, high protein intake during the first 3-5 days of ICU stay is also associated with increased long-term mortality. Therefore, timing of high protein intake may be relevant for optimizing ICU, in-hospital and long-term mortality outcomes.
在危重病期间，最佳蛋白质摄入量尚不清楚。关于 ICU 住院第一周营养支持的结果存在冲突。我们研究了需要长时间机械通气的 ICU 患者的蛋白质摄入时间和结局。
我们回顾性地收集了 2011 年 1 月 1 日至 2015 年 12 月 31 日期间在我们的 ICU 接受至少 7 天机械通气的成年危重病患者 ICU 入院的前 7 天的营养和临床数据。根据最近的文献，患者被分为 3 个蛋白质摄入类别，<0.8 g/kg/天，0.8-1.2 g/kg/天和>1.2 g/kg/天。我们的主要目的是确定与最低 6 个月死亡率相关的最佳蛋白质剂量和时间。次要终点是通气持续时间、需要肾脏替代治疗（RRT）、ICU 住院时间（LOS）和死亡率以及住院 LOS 和死亡率。
共有 455 名患者符合纳入标准。我们发现蛋白质摄入与死亡率之间存在时间依赖性关联；第 3 天前低蛋白摄入（<0.8 g/kg/天）和第 3 天后高蛋白摄入（>0.8 g/kg/天）与 6 个月死亡率较低相关，调整后的 HR 为 0.609；95%CI 0.480-0.772，p<0.001）与总体高蛋白摄入的患者相比。当从第 1-2 天的<0.8 g/kg/天逐渐增加到第 3-5 天的 0.8-1.2 g/kg/天，然后在第 5 天后增加到>1.2 g/kg/天时，发现最低的 6 个月死亡率。此外，总体低蛋白摄入与 ICU、住院和 6 个月死亡率最高相关。未发现 ICU LOS、需要 RRT 或通气持续时间的差异。
我们的数据表明，尽管总体低蛋白摄入与最高死亡率风险相关，但 ICU 住院前 3-5 天高蛋白摄入也与长期死亡率增加相关。因此，高蛋白摄入的时间可能与优化 ICU、住院和长期死亡率结果相关。
