Lee, Zheng-Yii and Dresen, Ellen and Lew, Charles Chin Han and Bels, Julia and Hill, Aileen and Hasan, M. Shahnaz and Ke, Lu and van Zanten, Arthur and van de Poll, Marcel C. G. and Heyland, Daren K. and Stoppe, Christian (2024) The effects of higher versus lower protein delivery in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. Critical Care, 28 (1). ISSN 1466-609X, DOI https://doi.org/10.1186/s13054-023-04783-1.
Full text not available from this repository.Abstract
BackgroundA recent large multicentre trial found no difference in clinical outcomes but identified a possibility of increased mortality rates in patients with acute kidney injury (AKI) receiving higher protein. These alarming findings highlighted the urgent need to conduct an updated systematic review and meta-analysis to inform clinical practice.MethodsFrom personal files, citation searching, and three databases searched up to 29-5-2023, we included randomized controlled trials (RCTs) of adult critically ill patients that compared higher vs lower protein delivery with similar energy delivery between groups and reported clinical and/or patient-centred outcomes. We conducted random-effect meta-analyses and subsequently trial sequential analyses (TSA) to control for type-1 and type-2 errors. The main subgroup analysis investigated studies with and without combined early physical rehabilitation intervention. A subgroup analysis of AKI vs no/not known AKI was also conducted.ResultsTwenty-three RCTs (n = 3303) with protein delivery of 1.49 +/- 0.48 vs 0.92 +/- 0.30 g/kg/d were included. Higher protein delivery was not associated with overall mortality (risk ratio RR]: 0.99, 95% confidence interval CI] 0.88-1.11; I2 = 0%; 21 studies; low certainty) and other clinical outcomes. In 2 small studies, higher protein combined with early physical rehabilitation showed a trend towards improved self-reported quality-of-life physical function measurements at day-90 (standardized mean difference 0.40, 95% CI - 0.04 to 0.84; I2 = 30%). In the AKI subgroup, higher protein delivery significantly increased mortality (RR 1.42, 95% CI 1.11-1.82; I2 = 0%; 3 studies; confirmed by TSA with high certainty, and the number needed to harm is 7). Higher protein delivery also significantly increased serum urea (mean difference 2.31 mmol/L, 95% CI 1.64-2.97; I2 = 0%; 7 studies).ConclusionHigher, compared with lower protein delivery, does not appear to affect clinical outcomes in general critically ill patients but may increase mortality rates in patients with AKI. Further investigation of the combined early physical rehabilitation intervention in non-AKI patients is warranted.Prospero IDCRD42023441059.
| Item Type: | Article |
|---|---|
| Funders: | UNSPECIFIED |
| Uncontrolled Keywords: | Critical illness; Protein; Physical rehabilitation; Systematic review |
| Subjects: | R Medicine R Medicine > RM Therapeutics. Pharmacology |
| Divisions: | Faculty of Medicine > Anaesthesiology Department |
| Depositing User: | Ms. Juhaida Abd Rahim |
| Date Deposited: | 14 Jun 2024 06:54 |
| Last Modified: | 14 Jun 2024 06:54 |
| URI: | http://eprints.um.edu.my/id/eprint/44176 |
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