Objective To investigate the effect of early protein supplementation on the clinical outcomes of elderly ICU patients with critically ill.Methods The study was a post-hoc analysis of a multicenter,cluster randomized controlled trial(NEED trial),which aimed to evaluate the impact of feeding protocol on nutritional implementation and outcomes in ICU patients.It was planned to include elderly patients aged≥70 years from the NEED trial,and patients who had not started nutritional therapy by the Day 3 after enrolment,stayed in the ICU less than 7 days,missing the primary outcome were excluded.The primary outcome of this study was 28-day mortality of enrolment.Patients were categorized into Q1(＜0.6 g/kg/d),Q2(0.6-0.83 g/kg/d),and Q3(≥ 0.83 g/kg/d)groups according to the tertiles of protein supply.The log-rank test was used to compare the Kaplan-Meier survival curves for 28-day mortality.The associations between different protein groups and 28-day mortality were tested by Cox proportional hazards regression models.Subgroup analysis was conducted in patients with high(mNUTRIC score ≥ 5)nutritional risk or patients with baseline acute kidney injury.Results A total of 789 elderly(≥ 70 years)patients was included in the study,with a mean protein amount of 0.69(0.53,0.91)g/(kg·d)during days 3-7 after ICU admission,and mean protein amounts in the Q1 low-protein group,the Q2 medium-protein group,and the Q3 high-protein group were 0.46(0.36,0.53),0.69(0.63,0.76),and 1.03(0.91,1.23)g/(kg·d),respectively.The results showed that the medium protein group associated with lower 28-day mortality compared to the high protein group,and the association between the medium protein group and lower 28-day mortality still held after controlling for possible confounders by Cox multivariate regression analysis.In the high-nutritional risk subgroup(mNUTRIC ≥ 5),a significant association was also found between the medium protein group and lower 28-day mortality.Conclusions Early high protein supply are not beneficial for elderly ICU patients by this large sample size post-hoc analysis,and medium protein supply associate with lower 28-day mortality compared with the high protein group.This study may provide a theoretical basis for the optimal dose of early protein supply in elderly ICU patients,as well as a reference for clinical implementation.
维普
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