Role of timing and dose of energy received in patients with acute lung injury on mortality in the Intensive Nutrition in Acute Lung Injury Trial (INTACT): a post hoc analysis

被引:40
|
作者
Braunschweig, Carol L. [1 ]
Freels, Sally [2 ]
Sheean, Patricia M. [3 ]
Peterson, Sarah J. [4 ]
Perez, Sandra Gomez [1 ]
McKeever, Liam [1 ]
Lateef, Omar [5 ]
Gurka, David [5 ]
Fantuzzi, Giamila [1 ]
机构
[1] Univ Illinois, Dept Kinesiol & Nutr, Chicago, IL 60607 USA
[2] Univ Illinois, Div Epidemiol & Biostat, Chicago, IL USA
[3] Loyola Univ, Dept Hlth Promot, Chicago, IL 60611 USA
[4] Rush Univ, Med Ctr, Dept Food & Nutr, Chicago, IL 60612 USA
[5] Rush Univ, Med Ctr, Dept Med, Chicago, IL 60612 USA
来源
AMERICAN JOURNAL OF CLINICAL NUTRITION | 2017年 / 105卷 / 02期
关键词
post hoc secondary analysis; medical nutrition therapy; randomized clinical trial; energy requirement; critical care; acute lung injury; energy dose and timing; threshold effect; CARE MEDICINE SCCM; NONTHYROIDAL ILLNESS; PARENTERAL-NUTRITION; METABOLIC-RESPONSE; AMERICAN SOCIETY; SUPPORT THERAPY; PROVISION; UNIT; GUIDELINES;
D O I
10.3945/ajcn.116.140764
中图分类号
R15 [营养卫生、食品卫生]; TS201 [基础科学];
学科分类号
100403 ;
摘要
Background: Our trial INTACT (Intensive Nutrition in Acute Lung Injury Trial) was designed to compare the impact of feeding from acute lung injury (ALI) diagnosis to hospital discharge, an interval that, to our knowledge, has not yet been explored. It was stopped early because participants who were randomly assigned to energy intakes at nationally recommended amounts via intensive medical nutrition therapy experienced significantly higher mortality hazards than did those assigned to standard nutrition support care that provided energy at 55% of recommended concentrations. Objective: We assessed the influence of dose and timing of feeding on hospital mortality. Design: Participants (n = 78) were dichotomized as died or discharged alive. Associations between the energy and protein received overall, early (days 1-7), and late (days >= 8) and the hazards of hospital mortality were evaluated between groups with multivariable analysis methods. Results: Higher overall energy intake predicted significantly higher mortality (OR: 1.14, 95% CI: 1.02, 1.27). Among participants enrolled for >= 8 (n = 66), higher early energy intake significantly increased the HR for mortality (HR: 1.17, 95% CI: 1.07, 1.28), whereas higher late energy intake was significantly protective (FIR: 0.91, 95% CI: 0.83, 1.0). Results were similar for early but not late protein (grams per kilogram) exposure (early-exposure HR: 8.9, 95% CI: 2.3, 34.3; late-exposure HR: 0.15, 95% CI: 0.02, 1.1). Threshold analyses indicated early mean intakes >= 18 kcal/kg significantly increased subsequent mortality. Conclusions: Providing kilocalories per kilogram or grams of protein per kilogram early post-ALI diagnosis at recommended levels was associated with significantly higher hazards for mortality, whereas higher late energy intakes reduced mortality hazards. This time varying effect violated the Cox proportionality assumption, indicating that feeding trials in similar populations should extend beyond 7 d and use time-varying statistical methods. Future trials are required for corroboration.
引用
收藏
页码:411 / 416
页数:6
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