Provision of protein and energy in relation to measured requirements in intensive care patients.
OBJECTIVE
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.


METHODS
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.


CONCLUSIONS
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.
Department of Intensive Care 4131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. matilde.allingstrup@rh.regionh.dk
Matilde Jo
MJ
Allingstrup
Negar
N
Esmailzadeh
Anne
A
Wilkens Knudsen
Kurt
K
Espersen
Tom
T
Hartvig Jensen
Jørgen
J
Wiis
Anders
A
Perner
Jens
J
Kondrup
D018806:APACHE; D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods*; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008875:Middle Aged; D009751:Nutritional Requirements; D018529:Nutritional Support; D016016:Proportional Hazards Models; D011446:Prospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome
D004044:Dietary Proteins