Evidence map›Paper›PMID 28098623›Full record

Observational studyCritical care medicine2017

Greater Protein and Energy Intake May Be Associated With Improved Mortality in Higher Risk Critically Ill Patients: A Multicenter, Multinational Observational Study.

Charlene Compher, Jesse Chittams, Therese Sammarco, Michele Nicolo, Daren K Heyland

4 registry-linked trialsAbstract readMulticenter StudyObservational Study
PubMed Publisher
In one paragraph

Observational study in Critical care medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 106 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
106citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03442946 completednot on this mapstarted 2018, after this paper: background citation

International Nutrition Survey 2018

TypeobservationalSponsorRWTH Aachen UniversityRan2018 to 2019Enrolled280ConditionsCardiovascular Surgery
NCT04242966 phase3withdrawnnot on this mapstarted 2020, after this paper: background citation

The Effect of Higher Protein Dosing in Critically Ill Patients: A Multicenter Registry-based Randomized Trial: The EFFORT Ultrasound a Sub-study

TypeinterventionalSponsorClinical Evaluation Research Unit at Kingston General HospitalRan2020 to 2022Enrolled0ConditionsCritical Illness, MalnutritionArmsUsual Care, Higher Protein/Amino Acid Group, Ultrasound measure
NCT04475666 narecruitingnot on this mapstarted 2020, after this paper: background citation

Replacing Protein Via Enteral Nutrition in a Stepwise Approach in Critically Ill Patients: An International, Multicenter Randomized Controlled Trial

TypeinterventionalSponsorKing Abdullah International Medical Research CenterRan2020 to 2026Enrolled2,502ConditionsCritical Illness, Nutrition DisordersArmsReplenish protein group, Standard protein group
NCT04607057 phase4unknown statusnot on this mapstarted 2020, after this paper: background citation

The Effect of Postoperative Supplemental Parenteral Nutrition (SPN) in Gastric Cancer Patients Who Underwent Gastrectomy: A Multicenter Prospective Randomized Controlled Trial

TypeinterventionalSponsorSeoul National University HospitalRan2020 to 2022Enrolled224ConditionsGastric Cancer, Gastrectomy, MalnutritionArmsParenteral Nutrition Solutions
3 · Its place in the literature

Who cites it

106 citing papers in PubMed, 8 syntheses or guidelines pooled it.

  1. Nutritional Risk Screening Recommendations for Critically Ill Patients: A Meta-Research Study and Quality Appraisal of Clinical Guidelines.Journal of human nutrition and dietetics : the official journal of the British Dietetic Association · 2026
    Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. [S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020
    Guideline
  8. NUTRIC score use around the world: a systematic review.Revista Brasileira de terapia intensiva · 2019
    Pooled it
  9. Trial
  10. Trial
  11. Trial
  12. Trial
  13. [Nutritional support in children with pneumonia on mechanical ventilation by short-peptide enteral nutrition formula].Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics · 2020
    Trial
  14. Trial
  15. Trial
  16. Trial
  17. Observational
  18. Review
  19. Review
  20. Article

46 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors.

Charlene Compher1Biobehavioral Health Sciences Department, University of Pennsylvania School of Nursing, Philadelphia, PA. 2Clinical Nutrition Support Services, Hospital of the University of Pennsylvania, Philadelphia, PA. 3Department of Critical Care Medicine, Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada.
Jesse Chittams
Therese Sammarco
Michele Nicolo
Daren K Heyland

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesControversy exists about the value of greater nutritional intake in critically ill patients, possibly due to varied patient nutritional risk. The objective of this study was to investigate whether clinical outcomes vary by protein or energy intake in patients with risk evaluated by the NUTrition Risk in the Critically Ill score.

designProspective observational cohort.

settingA total of 202 ICUs. PATIENTS: A total of 2,853 mechanically ventilated patients in ICU greater than or equal to 4 days and a subset of 1,605 patients in ICU greater than or equal to 12 days.

interventionsNone. MEASUREMENTS AND MAIN

resultsIn low-risk (NUTrition Risk in the Critically Ill, < 5) and high-risk (NUTrition Risk in the Critically Ill, ≥ 5) patients, mortality and time to discharge alive up to day 60 were assessed relative to nutritional intake over the first 12 days using logistic regression and Cox proportional hazard regression, respectively. In high-risk but not low-risk patients, mortality was lower with greater protein (4-d sample: odds ratio, 0.93; 95% CI, 0.89-0.98; p = 0.003 and 12-d sample: odds ratio, 0.90; 95% CI, 0.84-0.96; p = 0.003) and energy (4-d sample: odds ratio, 0.93; 95% CI, 0.89-0.97; p < 0.001 and 12-d sample: odds ratio, 0.88; 95% CI, 0.83-0.94; p < 0.001) intake. In the 12-day sample, there was significant interaction among NUTrition Risk in the Critically Ill category, mortality, and protein and energy intake, whereas in the 4-day sample, the test for interaction was not significant. In high-risk but not low-risk patients, time to discharge alive was shorter with greater protein (4-d sample: hazard ratio, 1.05; 95% CI, 1.01-1.09; p = 0.01 and 12-d sample: hazard ratio, 1.09; 95% CI, 1.03-1.16; p = 0.002) and energy intake (4-d sample: hazard ratio, 1.05; 95% CI, 1.01-1.09; p = 0.02 and 12-d sample: hazard ratio, 1.09; 95% CI, 1.03-1.16; p = 0.002). In the 12-day sample, there was significant interaction among NUTrition Risk in the Critically Ill category, time to discharge alive, and protein and energy intake, whereas in the 4-day sample, the test for interaction was not significant.

conclusionsGreater nutritional intake is associated with lower mortality and faster time to discharge alive in high-risk, longer stay patients but not significantly so in nutritionally low-risk patients.

Indexed as

Critical IllnessDietary ProteinsEnergy IntakeFemaleHumansIntensive Care UnitsLength of StayLogistic ModelsMaleMiddle AgedNutrition TherapyProportional Hazards ModelsProspective StudiesRespiration, ArtificialRisk FactorsDietary Proteins

Identifiers

PMID28098623

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.