重症患者蛋白质补充相关临床结局：多中心、多国家观察研究

　　目的：虽然与蛋白质摄入相关的结局非常有限，但能量和蛋白质的理想摄入与改善结局确实有关。我们旨在利用2013年国际营养调查数据评估所规定蛋白质补充量对死亡率和存活出院时间（TDA）的影响。我们推测蛋白质补充增加与死亡率降低和TDA缩短相关。

　　方法：纳入人群包括在重症监护病房（ICU）≥4天的患者（n=2828）和二次抽取的在ICU≥12天的患者（n=1584）。调整了模型的可评估营养天数，年龄，体质指数，性别，入院类型，敏感度评分和地理区域。利用logistic回归将规定蛋白质和能量摄入的百分率与死亡率结局和TDA的Cox比例风险进行比较。

　　结果：ICU≥4天的患者蛋白质和热量的平均摄入量分别是51g（规定的60.5%）和1100kcal（规定的64.1%）；ICU≥12天的患者蛋白质和热量的平均摄入量分别是57g（规定的66.7%）和1200g（规定的70.7%）。蛋白质补充量≥规定量的80%与死亡率的降低相关（ICU≥4天患者：比值比[OR]：0.68；95%可信区间[CI]：0.50～0.91；ICU≥12天患者：OR：0.60；95% CI：0.39～0.93），但是热量补充量≥规定量的80%无此效果。在ICU≥12天的患者中，蛋白质补充量≥规定量的80%时，TDA有所缩短（危害比[HR]：1.25；95% CI：1.04～1.49），而在ICU≥4天的患者中，蛋白质补充量≥规定量的80%时，TDA却延长（HR：0.82；95% CI：0.69～0.96）。

　　结论：补充蛋白质至少达到规定摄入量的80%对ICU患者生存和TDA缩短很重要。应尽可能补充规定的蛋白质摄入量。

JPEN J Parenter Enteral Nutr. 2016;40(1):45-51.

Clinical Outcomes Related to Protein Delivery in a Critically Ill Population: A Multicenter, Multinational Observation Study.

Nicolo M, Heyland DK, Chittams J, Sammarco T, Compher C.

Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Clinical Evaluation Research Unit, Kingston General Hospital, Ontario, Canada; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.

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.

KEYWORDS: ICU; energy; length of stay; mortality; predictive equation

PMID: 25900319

DOI: 10.1177/0148607115583675