Early high protein provision lowers mortality in ICU patients

Provision of high protein early appears to reduce hospital and intensive care unit (ICU) mortality among patients, especially those receiving continuous renal replacement therapy (CRRT), suggests a study. No association, however, is seen for septic patients.

A team of investigators performed a retrospective cohort study in 2,618 ICU patients with a feeding tube and on mechanically ventilation ≥48 h from 2003 to 2016. They explored 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 for the total group, for CRRT recipients, and for nonseptic and septic patients by Cox proportional hazards analysis.

Mean protein provision at day 4 was 0.96 g/kg/day. Early high protein provision significantly correlated with lower hospital mortality in the total group (hazard ratio [HR], 0.48, 95 percent confidence interval [CI], 0.39‒0.60; p=0.001), CRRT-receiving patients (HR, 0.62, 95 percent CI, 0.39‒0.99; p=0.045), and nonseptic patients (HR, 0.56, 95 percent CI, 0.44‒0.71; p<0.001).

However, such association was not observed in septic patients (HR, 0.71, 95 percent CI, 0.39‒1.29; p=0.264). Of note, associations found for ICU mortality were comparable.

Results of a sensitivity analysis for patients receiving a relative energy provision >50 percent remained robust in all groups except for those receiving CRRT.

“Early high protein provision is associated with lower hospital and ICU mortality in ICU patients, including CRRT-receiving patients,” the investigators said.