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Clinical Outcomes Related to Protein Delivery in a Critically Ill Population
Author(s) -
Nicolo Michele,
Heyland Daren K.,
Chittams Jesse,
Sammarco Therese,
Compher Charlene
Publication year - 2016
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607115583675
Subject(s) - medicine , confidence interval , odds ratio , hazard ratio , proportional hazards model , body mass index , intensive care unit , logistic regression , population , environmental health
Objective: Optimal intake of energy and protein is associated with improved outcomes, although outcomes relative to protein intake are very limited. Our purpose was to evaluate the impact of prescribed protein delivery on mortality and time to discharge alive (TDA) using data from the International Nutrition Survey 2013. We hypothesized that greater protein delivery would be associated with lower mortality and shorter TDA. Methods : The sample included patients in the intensive care unit (ICU) ≥4 days (n = 2828) and a subsample in the ICU ≥12 days (n = 1584). Models were adjusted for evaluable nutrition days, age, body mass index, sex, admission type, acuity scores, and geographic region. Percentages of prescribed protein and energy intake were compared with mortality outcomes using logistic regression and with Cox proportional hazards for TDA. Results : Mean intake for the 4‐day sample was protein 51 g (60.5% of prescribed) and 1100 kcal (64.1% of prescribed); for the 12‐day sample, mean intake was protein 57 g (66.7% of prescribed) and 1200 kcal (70.7% of prescribed). Achieving ≥80% of prescribed protein intake was associated with reduced mortality (4‐day sample: odds ratio [OR], 0.68; 95% confidence interval [CI], 0.50–0.91; 12‐day sample: OR, 0.60; 95% CI, 0.39–0.93), but ≥80% of prescribed energy intake was not. TDA was shorter with ≥80% prescribed protein (hazard ratio [HR], 1.25; 95% CI, 1.04–1.49) in the 12‐day sample but longer with ≥80% prescribed energy in the 4‐day sample (HR, 0.82; 95% CI, 0.69–0.96). Conclusion : Achieving at least 80% of prescribed protein intake may be important to survival and shorter TDA in ICU patients. Efforts to achieve prescribed protein intake should be maximized.