A Comparison of High and Usual Protein Dosing in Critically Ill Patients With Obesity: A Post Hoc Analysis of an International, Pragmatic, Single-Blinded, Randomized Clinical Trial*
Authors' conclusion
In critically ill patients with obesity, higher protein doses did not improve clinical outcomes, including those with higher nutritional and frailty risk.
Study context
- Population
- Critically ill adults with obesity (body mass index (BMI) ≥ 30 kg/m 2) at high nutritional risk, 85 ICUs in 16 countriesof 1301 in primary study
- Participants
- 425 adults
- Comparison
- High-dose vs usual-dose protein
- Primary endpoint
- Time to discharge alive (TTDA)
- Follow-up
- 60 days post-randomization
Methodological detailsinternational, multicentre, pragmatic, registry-based, single-blinded
- International
- Multicentre
- Pragmatic
- Registry-based
- Single-blinded
Primary result
As reported in the abstract
Nonsignificant slower rate of TTDA with higher protein, ruling out a clinically important benefit: HR
0.78
95% CI 0.58–1.05p = 0.10
Further findings
| Outcome | High protein | Usual protein | Risk difference (95% CI) | P value | |
|---|---|---|---|---|---|
| 60-day mortality | 31.5% | 28.2% | 3.3% (−5.4 to 12.1) | P = 0.46 | |
| −10−5051015Difference (linear scale) |
TTDA in subgroups (obesity classes, nutritional and frailty risk)
- No evidence of difference between protein groups, even after removal of patients with baseline AKI
Duration of MV, hospital and ICU LOS
- Not significantly different between groups
Original publication
A Comparison of High and Usual Protein Dosing in Critically Ill Patients With Obesity: A Post Hoc Analysis of an International, Pragmatic, Single-Blinded, Randomized Clinical Trial*. Crit Care Med. Published 6 November 2023. doi:10.
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