The Importance of Adequate Protein Intake in Critical Patients – Analysis of Data from an International Study
Adequate protein intake is a necessary part of care for critically ill patients and mitigates catabolic reactions associated with severe illness or injury. The benefits of proper determination and adherence to protein intake, however, have not been sufficiently assessed in detail. Therefore, this topic was the focus of a work analyzing data from an international observational multicenter study published in the Journal of Parenteral and Enteral Nutrition.
Introduction
Optimal setting of energy intake and protein intake is associated with better treatment outcomes in critically ill patients. The aim of the analysis of data collected in the international study was to evaluate the relationship between protein intake, mortality, and time spent in the ICU. The authors of the analysis worked with the hypothesis that the higher the protein intake, the lower the mortality and the shorter the ICU stay.
Evaluated Patient Population
Data from 2,828 patients hospitalized in the ICU for ≥ 4 days were analyzed, and from them, a subgroup of 1,584 individuals who stayed in the ICU for ≥ 12 days was further studied. The average age in both groups was about 60 years, and the average body mass index (BMI) was 27 kg/m2. The APACHE II (Acute Physiology and Chronic Health Evaluation) score was 22, the SOFA (Sequential Organ Failure Assessment) score was 9, and the NUTRIC (Nutrition Risk in the Critically Ill) score was 5 in both groups. The average length of stay in the ICU was 19.7 days for the first group, while for the second group, it was 34.9 days. The observed mortality was 31% and 25%, respectively.
Findings
The average protein intake in the first group of hospitalized patients (ICU stay ≥ 4 days) was 51 g, which represents 60.5% of the prescribed amount. Overall energy intake was 1,100 kcal (64.1% of the prescribed amount). In the second group of patients, protein intake was higher (57 g), representing 66.7% of the prescribed intake, and overall energy intake was also higher (1,200 kcal), which corresponds to 70.7% of the prescribed amount.
When achieving ≥ 80% of the prescribed protein intake, lower mortality was observed (odds ratio [OR] 0.68; 95% confidence interval [CI] 0.50–0.91 in the first group; OR 0.60; 95% CI 0.39–0.93 in the second group). No such connection was found when assessing total energy intake (achieving ≥ 80% of the prescribed kcal).
The average length of hospital stay was shorter for patients staying in the ICU for ≥ 12 days who achieved ≥ 80% of the prescribed protein intake compared to those with lower protein intake (hazard ratio [HR] 1.25; 95% CI 1.04–1.49). Prolonged ICU hospitalization, on the other hand, threatened the group of patients hospitalized for ≥ 4 days when achieving ≥ 80% of the prescribed energy intake (HR 0.82; 95% CI 0.69–0.96).
Summary and Conclusion
Achieving at least 80% of the recommended protein intake, which for critically ill patients is 2–3.5 g/kg/day, appears to be an important factor for higher survival rates and reduced ICU stay duration according to findings by American and Canadian experts. The authors of the study also emphasize the adequacy of overall energy intake, as excessive energy intake poses a burden on several organs and leads to fat deposits in the patients' liver.
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Source: Nicolo M., Heyland D. K., Chittams J. et al. Clinical outcomes related to protein delivery in a critically ill population: a multicenter, multinational observation study. J Parenter Enteral Nutr 2016; 40 (1): 45–51, doi: 10.1177/0148607115583675.
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