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Cited by 358Clinical Nutrition and GastroenterologySepsis Diagnosis and TreatmentHyperglycemia and glycemic control in critically ill and hospitalized patients

The DOI matches its Crossref record; 40 of the 40 references it cites were found in a registry or an index.

Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients

Open access
Weijs, Peter JM, Looijaard, Wilhelmus GPM, Beishuizen, Albertus, Girbes, Armand RJ, Oudemans-van Straaten, Heleen M·2014·Critical Care
DOI 10.1186/s13054-014-0701-zPMC PMC4279460
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Abstract

Introduction: Early protein and energy feeding in critically ill patients is heavily debated and early protein feeding hardly studied. Methods: A prospective database with mixed medical-surgical critically ill patients with prolonged mechanical ventilation (>72 hours) and measured energy expenditure was used in this study. Logistic regression analysis was used to analyse the relation between admission day-4 protein intake group (with cutoffs 0.8, 1.0, and 1.2 g/kg), energy overfeeding (ratio energy intake/measured energy expenditure > 1.1), and admission diagnosis of sepsis with hospital mortality after adjustment for APACHE II (Acute Physiology and Chronic Health Evaluation II) score. Results: A total of 843 patients were included. Of these, 117 had sepsis. Of the 736 non-septic patients 307 were overfed. Mean day-4 protein intake was 1.0 g/kg pre-admission weight per day and hospital mortality was 36%. In the total cohort, day-4 protein intake group (odds ratio (OR) 0.85; 95% confidence interval (CI) 0.73 to 0.99; P = 0.047), energy overfeeding (OR 1.62; 95%CI 1.07 to 2.44; P = 0.022), and sepsis (OR 1.77; 95%CI 1.18 to 2.65; P = 0.005) were independent risk factors for mortality besides APACHE II score. In patients with sepsis or energy overfeeding, day-4 protein intake was not associated with mortality. For non-septic, non-overfed patients (n = 419), mortality decreased with higher protein intake group: 37% for <0.8 g/kg, 35% for 0.8 to 1.0 g/kg, 27% for 1.0 to 1.2 g/kg, and 19% for ≥1.2 g/kg ( P = 0.033). For these, a protein intake level of ≥1.2 g/kg was significantly associated with lower mortality (OR 0.42, 95%CI 0.21 to 0.83, P = 0.013). Conclusions: In non-septic critically ill patients, early high protein intake was associated with lower mortality and early energy overfeeding with higher mortality. In septic patients early high protein intake had no beneficial effect on mortality.

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Figure 1 Flow chart.
Figure 1 Flow chart.CC BY · PubMed Central
Figure 2 Hospital mortality for septic and non-septic patients with protein intake higher and lower than 1.2 g/kg. * P = 0.003.
Figure 2 Hospital mortality for septic and non-septic patients with protein intake higher and lower than 1.2 g/kg. * P = 0.003.CC BY · PubMed Central
Figure 3 Hospital mortality for cumulative energy deficit over the first 4 days of ICU stay for non-septic patients (n = 726; P = 0.053). Reference is the measured resting energy expenditure of the patient. *P = 0.012.
Figure 3 Hospital mortality for cumulative energy deficit over the first 4 days of ICU stay for non-septic patients (n = 726; P = 0.053). Reference is the measured resting energy expenditure of the patient. *P = 0.012.CC BY · PubMed Central
Figure 4 Hospital mortality for all patients per protein intake group and for all non-septic and non-overfed patients per protein intake group. *P = 0.008; **P = 0.047.
Figure 4 Hospital mortality for all patients per protein intake group and for all non-septic and non-overfed patients per protein intake group. *P = 0.008; **P = 0.047.CC BY · PubMed Central

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Metadata

Authors
Weijs, P. J., Looijaard, W. G., Beishuizen, A., Girbes, A. R., & Oudemans-van Straaten, H. M.
Affiliations
  • Amsterdam University of Applied Sciences (NL)
  • Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
  • Medisch Spectrum Twente (NL)
  • Amsterdam Cardiovascular Sciences (NL)
Corresponding author
Weijs, Peter JM
ORCID
Venue
Critical Care
Publisher
Springer Science and Business Media LLC
Published
2014-12-14
Volume
18
Issue
6
Pages
701-701
ISSN
1364-8535 (ISSN-L)
DOI
10.1186/s13054-014-0701-z
PMC
PMC4279460
OpenAlex
W1981313739
Cited by
358
References
40
Citations by year
2026: 18 · 2025: 17 · 2024: 48 · 2023: 30 · 2022: 35 · 2021: 30 · 2020: 38 · 2019: 43 · 2018: 43 · 2017: 24 · 2016: 26 · 2015: 6
FWCI
17.38
Type
journal article
Language
en
Open access
Licence
Locations
  • Critical Care (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
  • Pure Amsterdam UMC (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
Keywords
mechanical ventilation, critically ill patients, sepsis, in-hospital mortality, energy expenditure, protein intake, nutritional support, mortality risk factors, APACHE II score, prolonged mechanical ventilation, intensive care unit patients, mortality prediction model, prognostic factors, prognostic score, prognostic score validation, prognostic score comparison
MeSH terms
Adult, Aged, Aged, 80 and over, Energy Intake, Dietary Proteins, Female, Humans, Male, Middle Aged, Prospective Studies, Respiration, Artificial, Cohort Studies, Critical Illness, Hospital Mortality, Overnutrition

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