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

Cheng Lv; Lingliang Zhou; Yufeng Zhou; Charles Chin Han Lew; Zheng-Yii Lee; M. Shahnaz Hasan; Baiqiang Li; Yang Liu; Jiajia Lin; Wenjian Mao; Christian Stoppe; Arthur Raymond Hubert van Zanten; Weiqin Li; Yuxiu Liu; Lu Ke; Chinese Critical Care Nutrition Trials Group (CCCNTG)

doi:10.1093/burnst/tkae027

Burns & Trauma ›› 2024, Vol. 12 ›› Issue (1) :tkae027 DOI: 10.1093/burnst/tkae027

Research Article

research-article

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

Cheng Lv ¹^,^†
, Lingliang Zhou ²^,^†
, Yufeng Zhou ³
, Charles Chin Han Lew ⁴
, Zheng-Yii Lee ⁵^,⁶
, M. Shahnaz Hasan ⁶^,⁷
, Baiqiang Li ¹^,⁸^,⁹
, Yang Liu ²
, Jiajia Lin ¹
, Wenjian Mao ¹
, Christian Stoppe ⁵^,¹⁰
, Arthur Raymond Hubert van Zanten ¹¹^,¹²
, Weiqin Li ¹^,⁸^,⁹
, Yuxiu Liu ³^,⁸^,⁹^,^*
, Lu Ke ¹^,⁸^,⁹^,^*
, Chinese Critical Care Nutrition Trials Group (CCCNTG)

Author information +

¹ Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University , 22 Hankou Road, Gulou District, Nanjing 210093, China

² Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Southeast University , 87 Ding Jiaqiao, Gulou District, Nanjing 210009, China

³ Department of Biostatistics, School of Public Health, Southern Medical University , 1023-1063 Shatai South Road, Baiyun District, Guangzhou 510515, China

⁴ Department of Dietetics and Nutrition, Ng Teng Fong General Hospital , Singapore, Singapore 1 Jurong East Street 21, Singapore

⁵ Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin , Charitéplatz 1, 10117 Berlin, Germany

⁶ Department of Anaesthesiology, Faculty of Medicine, University of Malaya , Lembah Pantai, Kuala Lumpur 50603, Malaysia

⁷ Department of Anaesthesiology, Universiti Malaya Medical Centre , Lembah Pantai, Kuala Lumpur 59100, Malaysia

⁸ National Institute of Healthcare Data Science, Nanjing University , 22 Hankou Road, Gulou District, Nanjing 210093, China

⁹ Research Institute of Critical Care Medicine and Emergency Rescue At Nanjing University , 22 Hankou Road, Gulou District, Nanjing 210093, Jiangsu Province, China

¹⁰ Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg , Oberdürrbacher Str. 6, 97080, Würzburg, Germany

¹¹ Department of Intensive Care, Gelderse Vallei Hospital , Willy Brandtlaan 10, 6716 RP Ede, The Netherlands

¹² Division of Human Nutrition and Health, Wageningen University & Research , Helix (Building 124), Stippeneng 4, 6708 WE Wageningen, The Netherlands

^*Yuxin Liu, Email: liu_yuxiu@163.com;

Lu Ke, Email: kelu@nju.edu.cn

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Abstract

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 mortality[hazard 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.

Keywords

Protein delivery / Mortality / Acute kidney injury / Renal replacement therapy / Critical illness

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Cheng Lv, Lingliang Zhou, Yufeng Zhou, Charles Chin Han Lew, Zheng-Yii Lee, M. Shahnaz Hasan, Baiqiang Li, Yang Liu, Jiajia Lin, Wenjian Mao, Christian Stoppe, Arthur Raymond Hubert van Zanten, Weiqin Li, Yuxiu Liu, Lu Ke, Chinese Critical Care Nutrition Trials Group (CCCNTG). Early protein delivery in critically ill patients with acute kidney injury: post hoc analysis of a multicenter cluster-randomized controlled trial. Burns & Trauma, 2024, 12 (1) : tkae027 DOI:10.1093/burnst/tkae027

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