Industrial Engineering and Management, Ariel University, Ariel 40700, Israel.
Data Science and Artificial Intelligence Research Center, Ariel University, Ariel 40700, Israel.
Nutrients. 2024 Sep 26;16(19):3258. doi: 10.3390/nu16193258.
Finding the best energy and protein dose and timing for critically ill patients remains challenging. Distinct populations may react differently to protein load. This study aimed to characterize and predict outcomes of critically ill patients who received moderate energy and high or low protein doses during their stay in the intensive care unit (ICU).
The cohort included 646 adult patients (70% men and 30% women) hospitalized in Beilinson Hospital ICU (Petah Tikva, Israel) for over 5 days between 2011 and 2018. Patients received 10-20 kcal/kg/day and were classified into two groups: low (LP) and high (HP) protein support (≤1 g/kg/day vs. >1 g/kg/day), the LP group comprising 531 patients (82%) and the HP group 115 patients (18%). Multiple logistic regression was used to describe associations between patients' characteristics and 90-day survival in the LP and HP groups.
Among LP, increased age, APACHE II, and receiving supplemental parenteral nutrition (SPN) were associated with decreased survival (OR = 0.986, 95% CI [0.973, 0.999]; OR = 0.915, 95% CI [0.886, 0.944], OR = 0.579, 95% CI [0.366, 0.917]). Trauma admission was associated with increased survival (OR = 1.826, 95% CI [1.001, 3.329]). Among HP, increased age was associated with decreased survival (OR = 0.956, 95% CI [0.924, 0.998]). Higher BMI was associated with improved survival (OR = 1.137, 95% CI [1.028, 1.258]). Likewise, in the HP group, the BMI of elderly survivors was higher compared to non-survivors (27.1 ± 6.2 vs. 24.7 ± 4.8, t (113) = 2.3, < 0.05).
Our results show that in patients with moderate energy support and low protein administration, survivors were younger, with a lower APACHE II score, mainly suffering from trauma and without renal failure. In the patients receiving high protein support, younger patients with a high BMI not suffering from sepsis were more likely to survive. We suggest confirming these findings with prospective RCTs.
为危重症患者寻找最佳能量和蛋白质剂量及时间仍然具有挑战性。不同人群对蛋白质负荷的反应可能不同。本研究旨在描述并预测在重症监护病房（ICU）住院时间超过 5 天的危重症患者接受中等能量和高或低蛋白质剂量的特征和结局。
该队列纳入了 2011 年至 2018 年在以色列佩塔提克瓦贝林森医院 ICU 住院超过 5 天的 646 名成年患者（70%为男性，30%为女性）。患者接受 10-20kcal/kg/天，并分为两组：低蛋白（LP）和高蛋白（HP）支持（≤1g/kg/天与>1g/kg/天），LP 组包括 531 名患者（82%）和 HP 组 115 名患者（18%）。多变量逻辑回归用于描述 LP 和 HP 组患者特征与 90 天生存率之间的关系。
在 LP 组中，年龄增加、APACHE II 评分和接受补充肠外营养（SPN）与生存率降低相关（OR=0.986，95%CI[0.973，0.999]；OR=0.915，95%CI[0.886，0.944]，OR=0.579，95%CI[0.366，0.917]）。创伤入院与生存率增加相关（OR=1.826，95%CI[1.001，3.329]）。在 HP 组中，年龄增加与生存率降低相关（OR=0.956，95%CI[0.924，0.998]）。较高的 BMI 与生存率提高相关（OR=1.137，95%CI[1.028，1.258]）。同样，在 HP 组中，高龄幸存者的 BMI 高于非幸存者（27.1±6.2 与 24.7±4.8，t（113）=2.3，<0.05）。
我们的结果表明，在接受中等能量支持和低蛋白治疗的患者中，幸存者年龄较小，APACHE II 评分较低，主要患有创伤且无肾功能衰竭。在接受高蛋白支持的患者中，无脓毒症的年轻高 BMI 患者更有可能存活。我们建议通过前瞻性 RCT 来证实这些发现。
