Protein Intake, Nutritional Status and Outcomes in ICU Survivors: A Single Center Cohort Study

Abstract

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.

Economic costs of dysphagia among hospitalized patients

“…Attention may focus on the acute injury, and caregivers may fail to identify further decline in swallow function while the individual is experiencing pain or distress. At the same time, metabolic needs are raised following injury and during recovery, necessitating a high‐protein diet to prevent excessive loss of muscle mass and protein malnutrition from occurring . Inability to accelerate diet by food choices (often limited within a hospital setting) or consumed volume (if swallow is compromised) may delay or impair recovery of function and healing of wounds.…”

“…At the same time, metabolic needs are raised following injury and during recovery, necessitating a high-protein diet to prevent excessive loss of muscle mass and protein malnutrition from occurring. 13 Inability to accelerate diet by food choices (often limited within a hospital setting) or consumed volume (if swallow is compromised) may delay or impair recovery of function and healing of wounds. The effects of a major injury such as hip fracture may compound preexisting swallowing dysfunction or destabilize deglutition enough to overwhelm physiological reserve precipitating aspiration or pneumonia.…”

Seven Deadly Sins of Nutrition Therapy in Critically Ill Patients

“…The main nutrition guidelines for critically ill patients agree that excessive calorie supply in the first days of critical illness should be avoided, proposing a modest calorie goal for the first week (15–20 kcal/kg/d) and prioritizing protein (≈1.5 g/kg/d) and reevaluation after 5 to 7 days to maintain or adjust nutrition goals . Although adequate protein intake has been the cornerstone of nutrition support for severe patients, excess protein (or its early administration) has been the subject of debate and concern among many nutrition support teams. Although the underlying mechanisms are not fully understood, a strong supply of protein has been linked to increased urea generation, increased catabolism mediated by increased glucagon synthesis, reduced myofibrils synthesis, and interference with autophagy processes …”

Experimental and Outcome‐Based Approaches to Protein Requirements in the Intensive Care Unit

“…It is advised that ICU patients with low muscle mass who can be fed adequately with enteral feeding should be fed with adequate amounts of protein to improve outcome. Weijs et al 48 also studied 801 medical ICU/hospital survivors, of whom 473 were assessed by a research dietitian as malnourished within 48 hours of admission. Higher than 1.2 g protein/kg intake was related to 17% lower 90‐day postdischarge mortality, while 30% lower mortality was observed in the malnourished subgroup.…”