The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observational study (original) (raw)
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Background: Critically ill patients admitted to the intensive care unit (ICU) are often hyper-metabolic and hyper-catabolic and at risk of malnutrition. This study aimed to evaluate the amount of energy and protein intake and its correlation with the required amount in critically ill patients. Method: Seventy patients with critical conditions who were admitted to ICU were eligible (age ≥18 years and over a 3-day stay in ICU). Basic characteristics, medical history, and laboratory test results were extracted from the patients' medical records. Anthropometric indices and APACHE II questionnaire were assessed by an expert nurse. The calorie and protein requirement of patients were considered 25 kcal/kg/day and 1.2 g/kg/day, respectively. Result: Mean age in the target population was 57.69 ± 20.81 years, and 48.6% were men. The mean actual energy intake was significantly lower than the requirement (531.27 ±365.40 vs. 1583.77 ± 329.36 Kcal/day, P˂0.001). The mean actual protein intak...
Provision of protein and energy in relation to measured requirements in intensive care patients
Clinical Nutrition, 2011
Background & aims: Adequacy of nutritional support in intensive care patients is still a matter of investigation. This study aimed to relate mortality to provision, measured requirements and balances for energy and protein in ICU patients. Design: Prospective observational cohort study of 113 ICU patients in a tertiary referral hospital. Results: Death occurred earlier in the tertile of patients with the lowest provision of protein and amino acids. The results were confirmed in Cox regression analyses which showed a significantly decreased hazard ratio of death with increased protein provision, also when adjusted for baseline prognostic variables (APACHE II, SOFA scores and age). Provision of energy, measured resting energy expenditure or energy and nitrogen balance was not related to mortality. The possible cause-effect relationship is discussed after a more detailed analysis of the initial part of the admission. Conclusion: In these severely ill ICU patients, a higher provision of protein and amino acids was associated with a lower mortality. This was not the case for provision of energy or measured resting energy expenditure or energy or nitrogen balances. The hypothesis that higher provision of protein improves outcome should be tested in a randomised trial.
Critical care (London, England), 2014
IntroductionEarly protein and energy feeding in critically ill patients is heavily debated and early protein feeding hardly studied.MethodsA 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.ResultsA 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% confid...
Protein intake, nutritional status and outcomes in ICU survivors : Nutritional aspects in the ICU
Intensive Care Medicine Experimental, 2016
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.
Nutrition During Critical Care: An Audit on Actual Energy and Protein Intakes
Journal of Parenteral and Enteral Nutrition, 2020
Introduction: Oral nutrition is delivered frequently in intensive care units (ICUs) but rarely studied. The primary objective of this study was to quantify nutrition intakes in patients exclusively orally fed (OF) and in those receiving medical nutrition solutions or both. Methods: Adults who stayed in a mixed ICU for ≥3 days were studied. Nutrition deficits were calculated as the difference between estimated energy or protein targets (determined by weight-based formulas) and actual intakes (recorded on a daily basis by nurses). Total volumes of enteral or parenteral nutrition solutions, propofol, and glucose infused over 24 hours were collected and energy and protein amounts were calculated. In OF patients, food intake at each meal (breakfast, lunch, and dinner) was estimated using the "one-quarter portion" method. Results: Among the 289 included patients aged 67 (57-75.5) years, 253 were fed and received, on average, 14.3 (7.8-19) kcal/kg/d and 0.53 (0.27-0.8) g/kg/d protein. In OF patients (n = 126), intakes were 9.7 (5.8-19) kcal/kg/d and 0.35 (0.17-0.57) g/kg/d protein. In the subset of OF patients with ICU stay ≥ 7 days (n = 37), respectively, 51% and 94% never received ≥80% of their energy and protein targets. Conclusion: Nutrition intakes were lower by oral feeding compared with other exclusive or combined medical nutrition. Compared with the prescribed amounts, the deficit was larger for proteins than for energy.
Nutritional therapy and outcomes in underweight critically ill patients
Clinical Nutrition, 2019
Background & aims: Critically ill patients with body mass index (BMI) < 20 kg/m 2 have worse outcomes than normal/overweight patients possibly because underweight is a marker of malnutrition. To assess the effects of nutrition therapy in this population during the first week of an ICU stay. Methods: Prospective, 2-centre, observational study. Nutritional evaluations were performed between days 2 and 3 (first) and between days 5 and 7 (second) of ICU admission. In the first evaluation, patients were divided into non-fed (without nutritional support) and early-fed (those already receiving nutritional support) groups. In the second evaluation, patients were divided according to caloric intake (or<20 kcal/kg) and protein intake (or<1.3 g of protein/kg). Results: Of the 4236 patients screened and 342 were included in the cohort. Mortality was 58.5% (median 21 [11e38.25] days of follow-up). Unadjusted patient survival was worse in the non-fed group than in the early-fed group (HR 1.66; 95%CI, 1.18 to 2.32). There was no difference in mortality between groups after adjusting for the SOFA score on the day of the evaluation. At the second evaluation, unadjusted analysis showed better in-hospital survival in patients with higher caloric (HR0.58; 95%CI, 0.40 to 0.86) and protein intake (HR0.59; 95%CI, 0.42 to 0.82); there was no association between mortality and caloric or protein intake after adjusting for the SOFA score on the day of the evaluation. Conclusion: Nutritional therapy in the first week of ICU stay did not affect vital outcome after adjusting for the SOFA score on the day of the evaluation in underweight critically ill patients. Clinical trial registry: ClinicalTrials.gov number NCT03398343.
Nutritional Status and Mortality in the Critically Ill
Critical care medicine, 2015
The association between nutritional status and mortality in critically ill patients is unclear based on the current literature. To clarify this relation, we analyzed the association between nutrition and mortality in a large population of critically ill patients and hypothesized that mortality would be impacted by nutritional status. Retrospective observational study. Single academic medical center. Six thousand five hundred eighteen adults treated in medical and surgical ICUs between 2004 and 2011. None. All cohort patients received a formal, in-person, standardized evaluation by a registered dietitian. The exposure of interest, malnutrition, was categorized as nonspecific malnutrition, protein-energy malnutrition, or well nourished and determined by data related to anthropometric measurements, biochemical indicators, clinical signs of malnutrition, malnutrition risk factors, and metabolic stress. The primary outcome was all-cause 30-day mortality determined by the Social Security ...
Nutrition in Clinical Practice, 2020
BackgroundStudies examining nutrition intake of critically ill patients following liberation from mechanical ventilation (LMV) are scarce. The objectives of this prospective, observational feasibility study were to quantify and assess protein and energy intake in hospitalized, critically ill patients following LMV, to determine barriers to optimal intake, and to report on the feasibility of recruiting and retaining patients into this study.MethodsAdult patients requiring MV for >72 hours in a medical/surgical intensive care unit (ICU) were recruited. Protein and energy intakes were quantified up to 14 days following LMV. Patients also identified barriers to eating.ResultsNineteen patients (mean age, 60 years [SD, 12 years]) were studied over 125 days. Over all study days, the median amounts of protein and energy consumed in comparison with amounts prescribed by dietitians were 46% (interquartile range [IQR], 26–100) and 71% (IQR, 38–100), respectively. When stratified by route of...
Meeting Calorie and Protein Needs in the Critical Care Unit: A Prospective Observational Pilot Study
Nutrition and Metabolic Insights, 2020
Background:Inadequate calorie and protein intake during critical illness is associated with poor clinical outcomes. Unfortunately, most critically ill patients do not consume adequate levels of these nutrients. An enteral formula with appropriate macronutrient composition may assist patients in meeting nutritional goals.Design:This study was a single center, prospective, observational study of 29 adults in the medical intensive care unit who required enteral nutrition for at least 3 days. Subjects received a calorically dense, enzymatically hydrolyzed 100% whey peptide-based enteral formula for up to 5 days to assess the ability to achieve 50% of caloric goals within the first 3 days (primary outcome), the daily percentage of protein goals attained and gastrointestinal tolerance (secondary outcomes).Result:A total of 29 subjects consented and began the study. Four subjects dropped out before first day and 25 subjects were included in analyses. Subjects were aged 55.5 ± 16.9 years wi...
Protein Intake, Nutritional Status and Outcomes in ICU Survivors: A Single Center Cohort Study
Journal of Clinical Medicine
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 mor...