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Nutrition in acute and chronic diseases

Early high protein provision and mortality in ICU patients including those receiving continuous renal replacement therapy

European Journal of Clinical Nutrition volume 76, pages 1303–1308 (2022)Cite this article

Subjects

Abstract

Background

Findings on the association between early high protein provision and mortality in ICU patients are inconsistent. The relation between early high protein provision and mortality in patients receiving CRRT remains unclear. The aim was to study the association between early high protein provision and hospital and ICU mortality and consistency in subgroups.

Methods

A retrospective cohort study was conducted in 2618 ICU patients with a feeding tube and mechanically ventilated ≥48 h (2003–2016). The association between early high protein provision (≥1.2 g/kg/day at day 4 vs. <1.2 g/kg/day) and hospital and ICU mortality was assessed for the total group, for patients receiving CRRT, and for non-septic and septic patients, by Cox proportional hazards analysis. Adjustments were made for APACHE II score, energy provision, BMI, and age.

Results

Mean protein provision at day 4 was 0.96 ± 0.48 g/kg/day. A significant association between early high protein provision and lower hospital mortality was found in the total group (HR 0.48, 95% CI 0.39–0.60, p = <0.001), CRRT-receiving patients (HR 0.62, 95% CI 0.39–0.99, p = 0.045) and non-septic patients (HR 0.56, 95% CI 0.44–0.71, p = <0.001). However, no association was found in septic patients (HR 0.71, 95% CI 0.39–1.29, p = 0.264). These associations were very similar for ICU mortality. In a sensitivity analysis for patients receiving a relative energy provision >50%, results remained robust in all groups except for patients receiving CRRT.

Conclusions

Early high protein provision is associated with lower hospital and ICU mortality in ICU patients, including CRRT-receiving patients. There was no association for septic patients.

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Acknowledgements

We thank Ronald Driessen and Patrick Thoral, Department of Adult Intensive Care Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands, for their contribution.

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Authors and Affiliations

  1. Department of Adult Intensive Care Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands

    Isabel M. van Ruijven, Sandra N. Stapel, Armand R. J. Girbes & Peter J. M. Weijs

  2. Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands

    Isabel M. van Ruijven & Peter J. M. Weijs

  3. Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands

    Isabel M. van Ruijven & Peter J. M. Weijs

  4. Department of Internal Medicine, Division of Dietetics, Erasmus University Medical Center, Rotterdam, The Netherlands

    Isabel M. van Ruijven

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  4. Peter J. M. Weijs
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Contributions

IR, SS, and PW designed the study. IR obtained the data, performed statistical analysis, and drafted the paper. SS and PW coordinated the study. SS, PW, and AG helped to draft the paper. All authors read and approved the final paper.

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Correspondence to Peter J. M. Weijs.

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van Ruijven, I.M., Stapel, S.N., Girbes, A.R.J. et al. Early high protein provision and mortality in ICU patients including those receiving continuous renal replacement therapy. Eur J Clin Nutr 76, 1303–1308 (2022). https://doi.org/10.1038/s41430-022-01103-8

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