Evidence map›Paper›PMID 39455305›Full record

Trial reportBritish journal of anaesthesia2024

The effect of high protein dosing in critically ill patients: an exploratory, secondary Bayesian analyses of the EFFORT Protein trial.

Ryan W Haines, Anders Granholm, Zudin Puthucheary, Andrew G Day, Danielle E Bear, John R Prowle, Daren K Heyland

Abstract readRandomized Controlled TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in British journal of anaesthesia, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Trial
  2. Review
  3. Review
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Ryan W HainesAdult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK; William Harvey Research Institute, Queen Mary University of London, London, UK.
Anders GranholmDepartment of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
Zudin PuthuchearyAdult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK; William Harvey Research Institute, Queen Mary University of London, London, UK.
Andrew G DayClinical Evaluation Research Unit, Kingston Health Science Center, Kingston, ON, Canada.
Danielle E BearDepartment of Critical Care, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Department of Nutrition and Dietetics, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
John R ProwleAdult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK; William Harvey Research Institute, Queen Mary University of London, London, UK; Department of Renal Medicine and Transplantation, The Royal London Hospital, Barts Health NHS Trust, London, UK. Electronic address: j.prowle@qmul.ac.uk.
Daren K HeylandDepartment of Critical Care Medicine, Queen's University, Kingston, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe EFFORT Protein trial assessed the effect of high vs usual dosing of protein in adult ICU patients with organ failure. This study provides a probabilistic interpretation and evaluates heterogeneity in treatment effects (HTE).

methodsWe analysed 60-day all-cause mortality and time to discharge alive from hospital using Bayesian models with weakly informative priors. HTE on mortality was assessed according to disease severity (Sequential Organ Failure Assessment [SOFA] score), acute kidney injury, and serum creatinine values at baseline.

resultsThe absolute difference in mortality was 2.5% points (95% credible interval -6.9 to 12.4), with a 72% posterior probability of harm associated with high protein treatment. For time to discharge alive from hospital, the hazard ratio was 0.91 (95% credible interval 0.80 to 1.04) with a 92% probability of harm for the high-dose protein group compared with the usual-dose protein group. There were 97% and 95% probabilities of positive interactions between the high protein intervention and serum creatinine and SOFA score at randomisation, respectively. Specifically, there was a potentially relatively higher mortality of high protein doses with higher baseline serum creatinine or SOFA scores.

conclusionsWe found moderate to high probabilities of harm with high protein doses compared with usual protein in ICU patients for the primary and secondary outcomes. We found suggestions of heterogeneity in treatment effects with worse outcomes in participants randomised to high protein doses with renal dysfunction or acute kidney injury and greater illness severity at baseline.

Indexed as

Bayes TheoremCritical IllnessAcute Kidney InjuryAdultAgedCreatinineDietary ProteinsFemaleHumansIntensive Care UnitsMaleMiddle AgedOrgan Dysfunction ScoresTreatment OutcomeCreatinineDietary ProteinsBayesian analysisheterogeneity of treatment effectsintensive caremulti-organ failureprotein

Identifiers

PMID39455305
PMCPMC11589476

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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.