Background 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. Methods 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. Results 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. Conclusions 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.

中文翻译：

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急性肾损伤危重患者的早期蛋白质输送：多中心整群随机对照试验的事后分析。


背景 对于急性肾损伤 (AKI) 危重患者的最佳早期蛋白质输送存在争议。本研究旨在评估危重患者中 AKI 的存在是否影响早期蛋白质输送与 28 天死亡率之间的关联。方法 这是对一项多中心整群随机对照试验的数据进行事后分析，该试验纳入了新入院的重症患者 (n = 2772)。本研究包括没有慢性肾病且具有基线肾功能完整数据的参与者。主要结局是 28 天死亡率。 Cox 比例风险模型用于分析早期蛋白质输送（通过入组后第 3-5 天的平均蛋白质输送量反映）与 28 天死亡率之间的关联，以及基线 AKI 分期是否与这种关联相互作用。结果 总体而言，纳入了 2552 例患者，其中 567 例（22.2%）在入组时患有 AKI（111 例 I 期、87 例 II 期、369 例 III 期）。研究患者的平均早期蛋白质输送量为 0.60 ± 0.38 g/kg/天。在整个研究队列中，蛋白质输送量每增加 0.1 g/kg/天，28 天死亡率就会降低 5%[风险比 (HR) = 0.95； 95% 置信区间 (CI) 0.92-0.98，p < 0.001]。早期蛋白质输送和 28 天死亡率之间的关联与基线 AKI 阶段显着相互作用（调整后的相互作用 p = 0.028）。在无 AKI 的患者中，早期蛋白质输送量每增加 0.1 g/kg/天，28 天死亡率就会降低 4%（HR = 0.96；95%CI 0.92-0.99，p = 0.011），而在 AKI 患者中，28 天死亡率则降低 9%（HR = 0.96；95%CI 0.92-0.99，p = 0.011）。 AKI III 期患者中为 0.91；95%CI 0.84-0.99，p = 0.021。然而，在 AKI I 期和 II 期患者中无法观察到这种关联。 结论 增加早期蛋白质输送（直至接近指南建议）与无 AKI 和 AKI III 期危重患者的 28 天死亡率降低相关，但与 AKI I 或 II 期患者无关。