Effect of early protein supplementation on clinical outcomes of the elderly patients with critically ill
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.
万方数据
维普
