Protein Intake, Nutritional Status and Outcomes in ICU Survivors: A Single Center Cohort Study

Abstract

Background: We hypothesized that protein delivery during hospitalization in patients who survived critical care would be associated with outcomes following hospital discharge.

Methods: We studied 801 patients, age ≥ 18 years, who received critical care between 2004 and 2012 and survived hospitalization. All patients underwent a registered dietitian formal assessment within 48 h of ICU admission. The exposure of interest, grams of protein per kilogram body weight delivered per day, was determined from all oral, enteral and parenteral sources for up to 28 days. Adjusted odds ratios for all cause 90-day post-discharge mortality were estimated by mixed- effects logistic regression models.

Results: The 90-day post-discharge mortality was 13.9%. The mean nutrition delivery days recorded was 15. In a mixed-effect logistic regression model adjusted for age, gender, race, Deyo-Charlson comorbidity index, acute organ failures, sepsis and percent energy needs met, the 90-day post-discharge mortality rate was 17% (95% CI: 6⁻26) lower for each 1 g/kg increase in daily protein delivery (OR = 0.83 (95% CI 0.74⁻0.94; p = 0.002)).

Conclusions: Adult medical ICU patients with improvements in daily protein intake during hospitalization who survive hospitalization have decreased odds of mortality in the 3 months following hospital discharge.

Keywords: ICU Survivors; critical care; hospital readmission; malnutrition; mortality; outcomes; protein.

Figure 1

Box plots of daily protein delivery up to 10 days in patients who did and did not survive to 90-day post-discharge mortality, showing the median (white line), the third quartile (Q3) and first quartile (Q1) range of the data and data outliers (observations outside the 9–91 percentile range).

Figure 2

Forest plot of post-discharge mortality associated for each 1 g/kg/day increase in protein delivery in our study cohort. Odds ratios with corresponding 95% CIs shown of the individual outcomes under study. ^a Restricted to patients diagnosed with Malnutrition.