■在急性肾损伤(AKI)的危重患者中,最佳的早期蛋白质递送存在争议。本研究旨在评估早期蛋白质递送与28天死亡率之间的关联是否受到危重患者AKI的影响。
■这是对新入院的危重患者(n=2772)的多中心集群随机对照试验数据的事后分析。这项研究包括没有慢性肾脏疾病且具有关于基线肾功能的完整数据的参与者。主要结果是28天死亡率。Cox比例风险模型用于分析早期蛋白质递送之间的关联,通过入组后第3-5天的平均蛋白质输送来反映,28天死亡率和基线AKI阶段是否与这种关联相互作用。
■总的来说,包括2552例患者,其中567人(22.2%)在入学时患有AKI(111期I,87第二阶段,369阶段III)。研究患者中的平均早期蛋白质递送为0.60±0.38g/kg/天。在整个研究队列中,蛋白质递送量每增加0.1g/kg/天,28日死亡率降低5%[风险比(HR)=0.95;95%置信区间(CI)0.92-0.98,p<0.001].早期蛋白质递送和28天死亡率之间的关联与基线AKI阶段显著相互作用(调整后的相互作用p=0.028)。在没有AKI的患者中,早期蛋白质递送每增加0.1g/kg/天,28天死亡率(HR=0.96;95CI0.92-0.99,p=0.011)降低4%,在AKIIII期患者中降低9%(HR=0.91;95CI0.84-0.99,p=0.021)。然而,在I期和II期AKI患者中不能观察到这种关联.
■在无AKI和AKIIII期的危重患者中,早期蛋白递送增加(接近指南建议)与28天死亡率降低相关。但不是在那些有AKI阶段I或II。
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.