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Early protein delivery in critically ill patients with acute kidney injury: post hoc analysis of a multicenter cluster-randomized controlled trial

Background: There is controversy over the optimal early protein delivery in critically ill patients with acute kidney injury (AKI). This study aims to evaluate whether the association between early protein delivery and 28-day mortality was impacted by the presence of AKI in critically ill patients....

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Main Authors:	Lv, Cheng, Zhou, Lingliang, Zhou, Yufeng, Lew, Charles Chin Han, Lee, Zheng-Yii, Hasan, M. Shahnaz, Li, Baiqiang, Liu, Yang, Lin, Jiajia, Mao, Wenjian, Stoppe, Christian, van Zanten, Arthur Raymond Hubert, Li, Weiqin, Liu, Yuxiu, Ke, Lu, CCCNTG, Chinese Critical Care Nutr Trials Grp
Format:	Article
Published:	Oxford University Press 2024
Subjects:	R Medicine (General)
Online Access:	http://eprints.um.edu.my/46784/ https://doi.org/10.1093/burnst/tkae027
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spelling	my.um.eprints.467842024-12-31T07:58:47Z http://eprints.um.edu.my/46784/ Early protein delivery in critically ill patients with acute kidney injury: post hoc analysis of a multicenter cluster-randomized controlled trial Lv, Cheng Zhou, Lingliang Zhou, Yufeng Lew, Charles Chin Han Lee, Zheng-Yii Hasan, M. Shahnaz Li, Baiqiang Liu, Yang Lin, Jiajia Mao, Wenjian Stoppe, Christian van Zanten, Arthur Raymond Hubert Li, Weiqin Liu, Yuxiu Ke, Lu CCCNTG, Chinese Critical Care Nutr Trials Grp R Medicine (General) Background: There is controversy over the optimal early protein delivery in critically ill patients with acute kidney injury (AKI). This study aims to evaluate whether the association between early protein delivery and 28-day mortality was impacted by the presence of AKI in critically ill patients. Methods: This is a post hoc analysis of data from a multicenter cluster-randomised controlled trial enrolling newly admitted critically ill patients (n = 2772). Participants without chronic kidney disease and with complete data concerning baseline renal function were included in this study. The primary outcome was 28-day mortality. Cox proportional hazards models were used to analyze the association between early protein delivery, reflected by mean protein delivery from day 3-5 after enrollment, 28-day mortality and whether baseline AKI stages interacted with this association. Results: Overall, 2552 patients were included, among whom 567 (22.2%) had AKI at enrollment (111 stage I, 87 stage II, 369 stage III). Mean early protein delivery was 0.60 +/- 0.38 g/kg/day among the study patients. In the overall study cohort, each 0.1 g/kg/day increase in protein delivery was associated with a 5% reduction in 28-day mortalityhazard ratio (HR) = 0.95; 95% confidence interval (CI) 0.92-0.98, p < 0.001]. The association between early protein delivery and 28-day mortality significantly interacted with baseline AKI stages (adjusted interaction p = 0.028). Each 0.1 g/kg/day increase in early protein delivery was associated with a 4% reduction in 28-day mortality (HR = 0.96; 95%CI 0.92-0.99, p = 0.011) among patients without AKI and 9% (HR = 0.91; 95%CI 0.84-0.99, p = 0.021) among those with AKI stage III. However, such associations cannot be observed among patients with AKI stages I and II. Conclusions: Increased early protein delivery (up to close to the guideline recommendation) was associated with reduced 28-day mortality in critically ill patients without AKI and with AKI stage III, but not in those with AKI stage I or II. Oxford University Press 2024-07 Article PeerReviewed Lv, Cheng and Zhou, Lingliang and Zhou, Yufeng and Lew, Charles Chin Han and Lee, Zheng-Yii and Hasan, M. Shahnaz and Li, Baiqiang and Liu, Yang and Lin, Jiajia and Mao, Wenjian and Stoppe, Christian and van Zanten, Arthur Raymond Hubert and Li, Weiqin and Liu, Yuxiu and Ke, Lu and CCCNTG, Chinese Critical Care Nutr Trials Grp (2024) Early protein delivery in critically ill patients with acute kidney injury: post hoc analysis of a multicenter cluster-randomized controlled trial. Burns & Trauma, 12. tkae027. ISSN 2321-3868, DOI https://doi.org/10.1093/burnst/tkae027 <https://doi.org/10.1093/burnst/tkae027>. https://doi.org/10.1093/burnst/tkae027 10.1093/burnst/tkae027
institution	Universiti Malaya
building	UM Library
collection	Institutional Repository
continent	Asia
country	Malaysia
content_provider	Universiti Malaya
content_source	UM Research Repository
url_provider	http://eprints.um.edu.my/
topic	R Medicine (General)
spellingShingle	R Medicine (General) Lv, Cheng Zhou, Lingliang Zhou, Yufeng Lew, Charles Chin Han Lee, Zheng-Yii Hasan, M. Shahnaz Li, Baiqiang Liu, Yang Lin, Jiajia Mao, Wenjian Stoppe, Christian van Zanten, Arthur Raymond Hubert Li, Weiqin Liu, Yuxiu Ke, Lu CCCNTG, Chinese Critical Care Nutr Trials Grp Early protein delivery in critically ill patients with acute kidney injury: post hoc analysis of a multicenter cluster-randomized controlled trial
description	Background: There is controversy over the optimal early protein delivery in critically ill patients with acute kidney injury (AKI). This study aims to evaluate whether the association between early protein delivery and 28-day mortality was impacted by the presence of AKI in critically ill patients. Methods: This is a post hoc analysis of data from a multicenter cluster-randomised controlled trial enrolling newly admitted critically ill patients (n = 2772). Participants without chronic kidney disease and with complete data concerning baseline renal function were included in this study. The primary outcome was 28-day mortality. Cox proportional hazards models were used to analyze the association between early protein delivery, reflected by mean protein delivery from day 3-5 after enrollment, 28-day mortality and whether baseline AKI stages interacted with this association. Results: Overall, 2552 patients were included, among whom 567 (22.2%) had AKI at enrollment (111 stage I, 87 stage II, 369 stage III). Mean early protein delivery was 0.60 +/- 0.38 g/kg/day among the study patients. In the overall study cohort, each 0.1 g/kg/day increase in protein delivery was associated with a 5% reduction in 28-day mortalityhazard ratio (HR) = 0.95; 95% confidence interval (CI) 0.92-0.98, p < 0.001]. The association between early protein delivery and 28-day mortality significantly interacted with baseline AKI stages (adjusted interaction p = 0.028). Each 0.1 g/kg/day increase in early protein delivery was associated with a 4% reduction in 28-day mortality (HR = 0.96; 95%CI 0.92-0.99, p = 0.011) among patients without AKI and 9% (HR = 0.91; 95%CI 0.84-0.99, p = 0.021) among those with AKI stage III. However, such associations cannot be observed among patients with AKI stages I and II. Conclusions: Increased early protein delivery (up to close to the guideline recommendation) was associated with reduced 28-day mortality in critically ill patients without AKI and with AKI stage III, but not in those with AKI stage I or II.
format	Article
author	Lv, Cheng Zhou, Lingliang Zhou, Yufeng Lew, Charles Chin Han Lee, Zheng-Yii Hasan, M. Shahnaz Li, Baiqiang Liu, Yang Lin, Jiajia Mao, Wenjian Stoppe, Christian van Zanten, Arthur Raymond Hubert Li, Weiqin Liu, Yuxiu Ke, Lu CCCNTG, Chinese Critical Care Nutr Trials Grp
author_facet	Lv, Cheng Zhou, Lingliang Zhou, Yufeng Lew, Charles Chin Han Lee, Zheng-Yii Hasan, M. Shahnaz Li, Baiqiang Liu, Yang Lin, Jiajia Mao, Wenjian Stoppe, Christian van Zanten, Arthur Raymond Hubert Li, Weiqin Liu, Yuxiu Ke, Lu CCCNTG, Chinese Critical Care Nutr Trials Grp
author_sort	Lv, Cheng
title	Early protein delivery in critically ill patients with acute kidney injury: post hoc analysis of a multicenter cluster-randomized controlled trial
title_short	Early protein delivery in critically ill patients with acute kidney injury: post hoc analysis of a multicenter cluster-randomized controlled trial
title_full	Early protein delivery in critically ill patients with acute kidney injury: post hoc analysis of a multicenter cluster-randomized controlled trial
title_fullStr	Early protein delivery in critically ill patients with acute kidney injury: post hoc analysis of a multicenter cluster-randomized controlled trial
title_full_unstemmed	Early protein delivery in critically ill patients with acute kidney injury: post hoc analysis of a multicenter cluster-randomized controlled trial
title_sort	early protein delivery in critically ill patients with acute kidney injury: post hoc analysis of a multicenter cluster-randomized controlled trial
publisher	Oxford University Press
publishDate	2024
url	http://eprints.um.edu.my/46784/ https://doi.org/10.1093/burnst/tkae027
_version_	1821001866948902912
score	13.235796

Early protein delivery in critically ill patients with acute kidney injury: post hoc analysis of a multicenter cluster-randomized controlled trial

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