einstein (São Paulo). 13/Aug/2024;22(Suppl 2):MV022.

The effect of protein supply in critical cancer patients

DOI: 10.31744/einstein_journal/2024ABS_EISIC_MV022

Category: Nutrition/Metabolism

Introduction:

According to the National Cancer Institute, 704 thousand new cases of cancer are expected in Brazil for each year of the 2023-2025 triennium.⁽⁾ Malnutrition in cancer patients is common and largely multifactorial due to the direct and indirect effects of the tumor, treatments performed and psychological factors.⁽⁾

Objective:

To verify whether, in patients admitted to the ICU, a protein intake target of 2.0g/kg/day compared to a conservative protein intake target of 1.5g/kg/day may be associated with kidney damage as well as provide benefits such as reduced days on mechanical ventilation, ICU, hospital and reduced mortality rates in the ICU and hospital.

Methods:

Multicenter, randomized and controlled study. Patients admitted to the ICU using enteral and/or parenteral nutritional therapy were involved. Data related to nutritional therapy (calorie and protein), renal function and hospital outcomes were collected. Eligible patients were randomized into two groups of protein targets: Group 1 (G1) with 1.5g/kg/day and Group 2 (G2) with 2.0g/kg/day of protein supply.

Results:

125 patients were randomized, 60 patients in G2 and 65 in G1. Median age was 78.0 (59.5-87) years, 51.2% female, BMI 23.7 (20.2-27) kg/m2, NRS 2002 median 3.0 (2.0-4.0), NUTRIC median 4.0 (2.0-5.0) and SAPS 3 was 57.0 (36.0-67). There was no statistically significant difference between the groups in relation to demographic characteristics. The groups had no difference about serum creatinine level [0.74(0.59-0.91) versus 0.77 (0.57-1.02), p=0.913] mg/dL, urea [60.7(41.3- 80.2) versus 63.1 (38.6-95.7) mg/dL, p=0.83], length of hospital stay [19.0(15.0-31.5) versus 19.0 (11.7-30.0) days, P=0.617], duration of mechanical ventilation [7.0 (3.5-11.5) versus 8.5 (6.0-13.0) days, p=0.405]. However, the G2 group, target of higher protein consumption, had a shorter length of stay in the ICU [10.0 (7.0-17.2) versus 13.5 (10-21) days, p=0.017]. As expected, G2 had a higher protein intake [1.36 (0.97-1.7) versus 1.18 (1.02-1.4) g/kg/day, p=0.023] than G1. Furthermore, there was no statistically significant difference in the rate of hospital mortality (p=0.627) and dialysis (p=0.37).

Conclusion:

Higher protein intake targets have been shown to be safe in terms of preserving kidney function and may be associated with shorter ICU stays.