Impact of a High-protein Nutritional Intake on the Clinical Outcome of the Neurocritical Patients

Abstract

Disease-related malnutrition of neurocritical illness harms its treatment, which increases the mortality rate. The aim of this study was evaluating the effect of a high protein diet on the dietary factors, clinical outcome, and mortality rate of neurocritical patients. In a randomized controlled trial, 15 neurocritical patients were recruited in each group. The patients in the intervention and control groups received high protein and conventional protein regimens, respectively. The Clinical Extended Glasgow Outcome Scale (GOSE) measured at one, two, and three months later. Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, Glasgow Coma Scale, the serum level of transthyretin (TTR) on the first, 3^rd and fifth days of admission, and nitrogen balance (NB) at the baseline and fifth day of the study were recorded. Thirty patients, 15 in each group, entered into the study. There was no statistically significant difference in the baseline characteristics of the patients between the two groups of the study. The 28-days-mortality rate in the intervention and control group were 33.3% (n = 5) and 73.3% (n = 11), P-value = 0.034, respectively. The GOSE scores were higher in the patients who received a high protein diet, and lower in the patients with lower baseline TTR, higher APACHE-II score, older age, and a baseline negative nitrogen balance. The high protein diet may decrease the mortality rate, and improve the clinical outcome of neurocritical patients. The baseline TTR level, APACHE II score, and NB are prognostic factors for the prediction of the GOSE in neurocritical patients.

Keywords: APACHE-II score; Extended glasgow outcome scale; High-protein diet; Neurologic disorders; Nitrogen balance; Prealbumin.

Figure 1

Disposition of patients throughout the study

Figure 2

The comparison of the GCS score on different days between control and intervention group. These compared with the Tukey test post-hoc. There is no significant difference in the GCS level of patients between different days intergroup or intragroup

Figure 3

The comparison of the calorie received on different days between control and intervention group. These compared with the Tukey test post-hoc. The * Significant difference in the control group and the ** Significant difference in the intervention group between the Calorie/day received on the second, third, fourth and fifth day to the first. P-value = 0.001

Figure 4

The comparison of the protein received on different days between control and intervention group. These compared with the Tukey test post-hoc. The * Significant difference in the control group and the ** Significant difference in the intervention group between the protein/day received on the second, third, fourth and fifth day to the first. P-value = 0.001

Figure 5

The comparison of GOSE on different months between the control and intervention groups. These compared with the Tukey test post-hoc