The Impact of Early Protein Advancement in Critically Ill Patients with COVID-19: A Multicenter Cardinality Matching Study
Abdulrahman Alissa,1 Ghazwa B Korayem,2 Ohoud Aljuhani,3 Mashael AlFaifi,4,5 Lina I Alnajjar,2 Noura A L Souaan,6 Meshal Albassam,7 Aljoharah Alrayes,2 Sara Albishi,2 Reem Abdullah Alqahtani,2 Abdullah F Alharthi,8 Nasser Alkhushaym,6 Mohammed A Alhammad,6 Ramesh Vishwakarma,9 Aisha Alharbi,10 Samia...
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2025-02-01
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| Series: | Therapeutics and Clinical Risk Management |
| Subjects: | |
| Online Access: | https://www.dovepress.com/the-impact-of-early-protein-advancement-in-critically-ill-patients-wit-peer-reviewed-fulltext-article-TCRM |
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| Summary: | Abdulrahman Alissa,1 Ghazwa B Korayem,2 Ohoud Aljuhani,3 Mashael AlFaifi,4,5 Lina I Alnajjar,2 Noura A L Souaan,6 Meshal Albassam,7 Aljoharah Alrayes,2 Sara Albishi,2 Reem Abdullah Alqahtani,2 Abdullah F Alharthi,8 Nasser Alkhushaym,6 Mohammed A Alhammad,6 Ramesh Vishwakarma,9 Aisha Alharbi,10 Samiah Alsohimi,11 Abdalmohsen Ababtain,5 Hasan M Al-Dorzi,12– 14 Rahaf Alqahtani,4,12,15 Ghadah Almuaither,15 Layan A Alarifi,15 Ahlam Almutairi,15 Mada B Alharbi,2 Abeer A Alghamdi,2 Munirah F Alhmoud,15 Khalid Al Sulaiman4,12,15– 17 1Pharmaceutical Care Services, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia; 2Department of Pharmacy Practice, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia; 3Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; 4Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 5Pharmaceutical Services Administration, King Saud Medical City, Riyadh, Saudi Arabia; 6Pharmaceutical Care Department, Royal Commission Health Services Program, Jubail, Saudi Arabia; 7Intensive Care Department, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia; 8Department of Clinical Pharmacy, College of Pharmacy, Shaqra University, Al-Dawadmi Campus, Al-Dawadmi, 11961, Saudi Arabia; 9Norwich Medical School, University of East Anglia, Norwich, UK; 10Pharmaceutical Care Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia; 11Pharmaceutical Care Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia; 12King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard – Health Affairs., Riyadh, Saudi Arabia; 13Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 14College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 15College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 16Saudi Critical Care Pharmacy Research (SCAPE) Platform, Riyadh, Saudi Arabia; 17Saudi Society for Multidisciplinary Research Development and Education (SCAPE Society), Riyadh, Saudi ArabiaCorrespondence: Khalid Al Sulaiman, King Abdulaziz Medical City (KAMC) - Ministry of National Guard Health Affairs (MNGHA), King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard – Health Affairs, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Arabia PO Box 22490, Riyadh, 11426, Saudi Arabia, Email alsulaimankh@hotmail.comBackground: Limited evidence is available regarding the safety and effectiveness of early high protein intake in critically ill patients with COVID-19. Therefore, this study aims to assess the safety of early protein advancement during nutritional support in these patients.Methods: A multi-center retrospective cohort study included adult critically ill patients with COVID-19 admitted to Intensive Care Units (ICUs) at three centers in Saudi Arabia. Patients were grouped into two groups based on the protein intake at day three of feeding initiation into low protein (≤ 0.8 mg/kg/day) versus high protein (> 0.8 mg/kg/day) groups. Acute kidney injury (AKI) during the ICU stay was the primary endpoint, while the remaining were considered secondary endpoints.Results: The study included 466 patients, but after cardinality matching with a 2:1 ratio, 192 were in the lower protein group compared with 96 patients in the high protein group. The rate of AKI was low in the highprotein group compared with the low protein group on day three of feeding initiation (19.9% versus 12.7%); however, this was not statistically significant (OR 0.54; 95% CI 0.26, 1.33; p=0.2). Additionally, patients in the high protein group had a higher rate of atrial fibrillation than those in the low protein group (OR 2.33; 95% CI 1.18, 4.62; p=0.02). No differences were observed in 30-day and in-hospital mortality (HR1.33, 95% CI 0.91, 1.96; p=0.14 and HR 1.21, 95% CI: 0.85, 1.72; p=0.29, respectively).Conclusion: The advancement of protein in critically ill patients with COVID-19 was not associated with significant differences in the incidence of AKI. In contrast, the early advancement of protein in nutritional feeding within the first three days was associated with a higher incidence of atrial fibrillation.Keywords: protein, nutrition, intensive care units, critically ill, COVID-19, SARS-CoV-2, acute kidney injury, AKI, mortality |
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| ISSN: | 1178-203X |