(443) Provision of Low Versus High Protein in Critically Ill Surgical and Trauma Patients

Introduction: In critically ill patients, adequate nutritional intake plays an important role in clinical outcomes and guidelines recommend a protein goal of 1.2–2 g/kg in this patient population. Current literature lacks consistency regarding clinical outcomes associated with high protein versus low protein provisions in this patient population. The purpose of this study is to determine whether higher protein doses carry a therapeutic benefit to critically ill patients.

Methods: This was a single-center, retrospective study of critically ill surgical and trauma patients who received goal calorie and protein needs for at least 7 days up to 28 days. Patients who were under 18 years of age, prisoners, pregnant, had significant propofol use, received greater than 60% of caloric needs through oral nutrition, had altered metabolic requirements, terminal cancer, or a length of stay greater than 28 days were excluded. The primary objectives were length of stay and ICU length of stay. Secondary objectives were mortality at 28 days, ventilator-free days, incidence of acute kidney injury after 3 days, initiation of renal replacement therapy after 3 days, incidence of infectious disease at 28 days, change in SOFA score, and glycemic control. Statistical analysis was performed with JMP Pro 17. Demographic data and outcomes were analyzed with t-tests, Chi-squared tests, and Wilcoxon rank sum tests, where applicable.

Results: 121 patients were in the low protein group ( < 1.3 g/kg) and 86 patients were in the high protein group (≥1.3 g/kg) with a mean daily protein dose of 0.9 g/kg and 1.8 g/kg. Mean APACHE and SOFA scores were 16.5 and 5 with a shorter hospital and ICU length of stay in the low protein group (11 vs. 18 days, p< 0.05; 9 vs. 14 days, p< 0.05). Calories per day were significantly greater in the high protein group (17 vs. 22.2 kcal/kg, p< 0.05) with higher incidence of AKI (16.5% vs. 32.6%, p< 0.05), hypoglycemia (5% vs. 15.1%, p< 0.05), and hyperglycemia (42.2% vs. 64%; p< 0.05).

Conclusions: There was a statistically significant longer length of stay and ICU length of stay in the high protein group. These results suggest that in critically ill patients, higher protein doses may not carry additional benefit. Further analysis of notable populations is needed to determine the impact of protein provisions.