Protein intake and clinical outcomes in critically ill patients: A dose-response and pairwise meta-analysis of randomized controlled trials.

IF 2.8 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Health Promotion Perspectives Pub Date : 2025-07-15 eCollection Date: 2025-07-01 DOI:10.34172/hpp.025.43894

Mohaddeseh Badpeyma, Faezeh Ghalichi, Roghayeh Molani-Gol, Hamed Valizadeh, Yousef Javadzadeh, Ahmadreza Rasouli, Mohammad Alizadeh, Sorayya Kheirouri

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Abstract

Background: The optimal protein intake for critically ill patients remains uncertain. This systematic review and dose-response meta-analysis aimed to evaluate the effect of high-protein nutritional support on clinical outcomes in intensive care unit (ICU) patients.

Methods: Randomized controlled trials (RCTs) comparing high- versus low-protein nutrition in critically ill adults with similar energy intake were identified through PubMed, Web of Science, and Scopus (up to June 2023). A random-effects model was used to pool risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). Linear and non-linear trends were assessed using the one-stage cubic spline regression model.

Results: Twenty-three RCTs were included. The summary RR was 0.83 (95% CI: 0.64-1.08; I²=63.6%; n=17) for mortality and 1.05 (95% CI: 0.88-1.25; I²=0%; n=7) for infections. The summary MD was -0.23% (-0.76 to 0.29, I²=5.6%, n=14) for mechanical ventilation days, -0.40 (-1.11 to 0.32, I²=0%, n=17) for ICU days, 0.73 (-1.11 to 2.58, I²=6%, n=10) for hospital days, and -3.44 (-4.99 to -1.90; I²=16.4%; n=5) for muscle atrophy. There was no evidence of linear or nonlinear trends.

Conclusion: Although higher protein intake had no significant effect on mortality or length of stay, it was associated with reduced muscle wasting. This suggests a potential role in preserving lean mass and supporting long-term functional recovery.

Systematic review registration: PROSPERO CRD42024480303.

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危重病人的蛋白质摄入和临床结果：随机对照试验的剂量反应和两两荟萃分析。

背景：危重病人的最佳蛋白质摄入量仍不确定。本系统综述和剂量反应荟萃分析旨在评估高蛋白营养支持对重症监护病房（ICU）患者临床结局的影响。方法：通过PubMed， Web of Science和Scopus（截至2023年6月）确定了比较能量摄入相似的危重成人高蛋白和低蛋白营养的随机对照试验（rct）。采用随机效应模型合并风险比（rr）和平均差异（md）， 95%置信区间（ci）。采用单阶段三次样条回归模型评估线性和非线性趋势。结果：共纳入23项随机对照试验。死亡率的总RR为0.83 (95% CI: 0.64-1.08; I2=63.6%; n=17)，感染的总RR为1.05 （95% CI: 0.88-1.25; I2=0%; n=7）。机械通气天数的总体MD为-0.23% (-0.76 ~ 0.29,I2=5.6%, n=14)， ICU天数的MD为-0.40 (-1.11 ~ 0.32,I2=0%, n=17)，住院天数的MD为0.73 (-1.11 ~ 2.58,I2=6%, n=10)，肌肉萎缩天数的MD为-3.44 （-4.99 ~ -1.90,I2=16.4%, n=5）。没有证据表明存在线性或非线性趋势。结论：虽然高蛋白质摄入对死亡率或住院时间没有显著影响，但它与减少肌肉萎缩有关。这表明它在保持瘦体重和支持长期功能恢复方面具有潜在作用。系统评价注册：PROSPERO CRD42024480303。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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