Serum level of TNF-a, IL-1 and IL-6 and serum biomarkers after nutritional change in patients' ventilator-associated pneumonia.

Abstract

Background: This study aims to evaluate the effects of high-protein nutritional support (HPNS) combined with probiotics (Bifid Triple Viable Capsule) on the nutritional status, biochemical markers, and immune function in critically ill patients (CIPs) requiring mechanical ventilation, with a focus on preventing ventilator-associated pneumonia (VAP). The study explores how this intervention impacts serum albumin, prealbumin, and inflammatory cytokines (TNF-a, IL-1, IL-6), key nutritional and immune function indicators.

Methods: This study included 86 critically ill patients requiring mechanical ventilation in the ICU. Participants were randomly assigned to either a research group (n=46) receiving HPNS combined with probiotics (Bifid Triple Viable Capsule) or a control group (n=40) receiving standard nutritional support. The primary outcomes included changes in serum albumin, prealbumin, and inflammatory cytokines (TNF-a, IL-1, IL-6) and the incidence of VAP The study duration was 3 weeks, and biochemical markers and clinical outcomes were assessed at baseline and post-intervention. The patients' body mass index (BMI) and body weight are calculated and compared. A spectrophotometer measures the content of serum protein. The prevalence of ventilator-associated pneumonia is analysed by sputum gram staining. The clinical symptoms of patients with ventilator-associated pneumonia during ICU are monitored. ELISA detects serum levels of inflammatory cytokines TNF-a, IL-1 and IL-6.

Results: The research group demonstrated significant improvements in serum albumin and prealbumin levels and a lower TNF-a, IL-1, and IL-6 ratio than the control group (P< 0.05). The incidence of ventilator-associated pneumonia (VAP) was significantly lower in the research group (6.52%) compared to the control group (30%, P<0.05). Additionally, the research group showed higher BMI and body weight (P< 0.05), suggesting improved nutritional status following the intervention.

Conclusions: High-protein nutritional support combined with probiotics can significantly raise the nutritional conditions of critically ill patients and effectively prevent ventilator-associated pneumonia. This intervention enhanced key biochemical markers, such as serum albumin, prealbumin, and the albumin/total protein ratio, all of which are important indicators of nutritional status. The improvement in these markers suggests that HPNS supports tissue repair and immune function, which are crucial for recovery in ICU patients. Additionally, the combination of HPNS and probiotics reduced serum levels of inflammatory cytokines (TNF-a, IL-1, IL-6), which are commonly elevated in critically ill patients and contribute to developing infections like VAP By regulating the inflammatory response, this intervention may help reduce the risk of infection and promote faster recovery. The results of this study highlight the potential clinical value of HPNS combined with probiotics for improving the management of critically ill patients in ICU settings.