Association of PROtein and CAloric Intake and Clinical Outcomes in Adult SEPTic and Non-Septic ICU Patients on Prolonged Mechanical Ventilation: The PROCASEPT Retrospective Study.

Background: The optimal nutritional support for critically ill septic patients remains unknown. This study evaluates the associations of macronutrient intake during the first week of intensive care unit (ICU) admission and long-term clinical outcomes in septic and non-septic patients.

Methods: Prolonged mechanically ventilated patients were retrospectively studied. The association of protein (low: <0.8 g/kg/d, medium: 0.8-1.2 g/kg/d, high >1.2 g/kg/d) and energy intake (<80%, 80%-110%, 110% of target) during days 1-3 and 4-7 after ICU admission and 6-month mortality was analyzed for septic and non-septic patients separately.

Results: A total of 423 patients were investigated. Of these, 297 had sepsis. In the sepsis group, medium protein intake at days 4-7 was associated with lower 6-month mortality (hazard ratio [HR]: 0.646, 95% confidence interval [CI]: 0.418-0.996, P=0.048) compared with high intake. In the non-sepsis group, early high and late low protein intake were associated with higher 6-month mortality (HR: 3.902, 95% CI: 1.505-10.115, P=0.005; HR: 2.642, 95% CI: 1.128-6.189, P=0.025) compared with low and high protein intake, respectively. For energy intake, late energy intake of >110% was associated with decreased mortality in septic patients (HR: 0.400, 95% CI: 0.222-0.721, P=0.002), whereas in non-septic patients, late medium energy intake (80%-110%) was associated with better survival (HR: 0.379, 95% CI: 0.175-0.820, P=0.014), both compared with low energy intake.

Conclusion: Divergent associations of macronutrient intake were found; early high protein intake in non-septic patients, but not in septic patients, was found to be associated with higher 6-month mortality.