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Observational Study
. 2014 Dec 14;18(6):701.
doi: 10.1186/s13054-014-0701-z.

Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients

Peter J M Weijs  1   2   3 , Wilhelmus G P M Looijaard  4 , Albertus Beishuizen  5   6   7 , Armand R J Girbes  8   9 , Heleen M Oudemans-van Straaten  10   11
Affiliations
Observational Study

Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients

Peter J M Weijs et al. Crit Care. .

Abstract

Introduction: Early protein and energy feeding in critically ill patients is heavily debated and early protein feeding hardly studied.

Methods: A prospective database with mixed medical-surgical critically ill patients with prolonged mechanical ventilation (>72 hours) and measured energy expenditure was used in this study. Logistic regression analysis was used to analyse the relation between admission day-4 protein intake group (with cutoffs 0.8, 1.0, and 1.2 g/kg), energy overfeeding (ratio energy intake/measured energy expenditure > 1.1), and admission diagnosis of sepsis with hospital mortality after adjustment for APACHE II (Acute Physiology and Chronic Health Evaluation II) score.

Results: A total of 843 patients were included. Of these, 117 had sepsis. Of the 736 non-septic patients 307 were overfed. Mean day-4 protein intake was 1.0 g/kg pre-admission weight per day and hospital mortality was 36%. In the total cohort, day-4 protein intake group (odds ratio (OR) 0.85; 95% confidence interval (CI) 0.73 to 0.99; P = 0.047), energy overfeeding (OR 1.62; 95%CI 1.07 to 2.44; P = 0.022), and sepsis (OR 1.77; 95%CI 1.18 to 2.65; P = 0.005) were independent risk factors for mortality besides APACHE II score. In patients with sepsis or energy overfeeding, day-4 protein intake was not associated with mortality. For non-septic, non-overfed patients (n = 419), mortality decreased with higher protein intake group: 37% for < 0.8 g/kg, 35% for 0.8 to 1.0 g/kg, 27% for 1.0 to 1.2 g/kg, and 19% for ≥ 1.2 g/kg (P = 0.033). For these, a protein intake level of ≥ 1.2 g/kg was significantly associated with lower mortality (OR 0.42, 95%CI 0.21 to 0.83, P = 0.013).

Conclusions: In non-septic critically ill patients, early high protein intake was associated with lower mortality and early energy overfeeding with higher mortality. In septic patients early high protein intake had no beneficial effect on mortality.

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Figures

Figure 1
Figure 1
Flow chart.
Figure 2
Figure 2
Hospital mortality for septic and non-septic patients with protein intake higher and lower than 1.2 g/kg. * P = 0.003.
Figure 3
Figure 3
Hospital mortality for cumulative energy deficit over the first 4 days of ICU stay for non-septic patients (n = 726; P  = 0.053). Reference is the measured resting energy expenditure of the patient. *P = 0.012.
Figure 4
Figure 4
Hospital mortality for all patients per protein intake group and for all non-septic and non-overfed patients per protein intake group. *P = 0.008; **P = 0.047.
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