Clinical Outcomes Related to Protein Delivery in a Critically Ill Population: A Multicenter, Multinational Observation Study
Clinical Outcomes Related to Protein Delivery in a Critically Ill Population: A Multicenter, Multinational Observation Study
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DOI：
10.1177/0148607115583675
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发表时间：
2016-01-01
影响因子：
3.4
通讯作者：
Compher, Charlene
中科院分区：
文献类型：
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作者：
Nicolo, Michele;Heyland, Daren K.;Compher, Charlene
目的：最佳的能量和蛋白质摄入量与改善预后有关，尽管与蛋白质摄入量相关的预后非常有限。我们的目的是使用2013年国际营养调查的数据来评估处方蛋白质输送对死亡率和存活出院时间(TDA)的影响。我们假设，更多的蛋白质输送将与更低的死亡率和更短的TDA相关。方法：样本包括在重症监护病房(ICU)4天的患者(n=2828)和在ICU 12天的亚样本(n=1584)。根据可评估的营养天数、年龄、体重指数、性别、入院类型、视力评分和地理区域对模型进行调整。用Logistic回归和COX比例风险对TDA患者的死亡结果和蛋白质和能量摄入比例进行比较。结果：4日样本的平均摄入量为蛋白质51g(处方的60.5%)和1100千卡(处方的64.1%)，12日样本的平均摄入量为蛋白质57g(处方的66.7%)和1200kcal(处方的70.7%)。达到规定蛋白质摄入量的80%与死亡率的降低有关(4天样本：优势比[OR]，0.68；95%可信区间[CI]，0.50-0.91；12天样本：OR，0.60；95%可信区间，0.39-0.93)，但80%的规定能量摄入不相关。在12天的样本中，80%的规定蛋白质(危险比[HR]，1.25；95%CI，1.04-1.49)的TDA较短，而在4天的样本中，80%的规定能量的TDA较长(HR，0.82；95%的CI，0.69-0.96)。结论：达到规定蛋白质摄入量的至少80%可能对ICU患者的生存和缩短TDA很重要。应最大限度地努力达到规定的蛋白质摄入量。
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.