1301 analysed mechanically ventilated critically ill patients at high nutritional risk: 645 high-dose and 656 usual dose
Follow-up
60 days
Primary endpoint
Time to discharge alive from hospital
Result
Higher protein delivery did not improve time to discharge alive from hospital and may have worsened outcomes, particularly in patients with acute kidney injury and higher organ failure scores. Sixty-day mortality was 34.6% (222 of 642) with high-dose protein versus 32.1% (208 of 648) with the usual dose — relative risk 1.08 (95% CI 0.92 to 1.26).
Secondary endpoints
60-day mortality, outcomes by acute kidney injury and organ failure status
Delivery of higher doses of protein to mechanically ventilated critically ill patients did not improve the time-to-discharge-alive from hospital and might have worsened outcomes for patients with acute kidney injury and high organ failure scores.
The trial authors, in the published abstract
How it has aged
Reverses a decade of guideline advice to push protein hard in critical illness. The signal of harm in acute kidney injury is the practically important part, and TARGET Protein has since reinforced the neutral-to-negative picture.
Publications
The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial
Heyland DK, Patel J, Compher C, et al. The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial. Lancet 2023 Feb 18;401(10376):568-576.
No improvement in time to discharge alive
Possible harm in acute kidney injury and high organ failure scores