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The purpose of this study is to determine whether protein intake during the first days of intensive care admission, in relation to body composition at intensive care admission as assessed on computed tomography scans made during routine care, is are related to clinical outcome in critically ill patients.
Optimal protein and energy intake have been shown to be relevant for reducing mortality in prospective observational studies in mechanically ventilated patients admitted to the intensive care unit. However, nutritional status (protein mass, muscle mass) of patients at admission and possible consequences for clinical outcome are largely unknown. Computerized tomography scans can be used to assess muscle mass as a proxy for body protein mass.
The investigators are especially interested in the effect of protein intake on clinical outcome in intensive care patients with different body protein mass at admission. This is relevant for appropriate formulation of clinical (protein) nutrition in this patient group. Therefore, the relationship between protein intake and patient outcome is evaluated in intensive care patients with low muscle and normal muscle area, using muscle area from computed tomography scans as a proxy of body protein mass.
Additionally, data from computed tomography scans regarding muscle quality and muscle- and fat quantity are used to evaluate the prognostic value of body composition at intensive care admission. Finally, abdominal computed tomography scans are compared with thoracic computed tomography scans.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intensive care patients | Patients admitted to the intensive care unit for 4 days or more with a computed tomography scan made for clinical reasons early during intensive care stay and who receive enteral and/or parenteral nutrition as per hospital protocol |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Computed tomography scan made for clinical reasons | Other | Patients were included if a computed tomography scan of the abdomen or thorax was made early during intensive care admission (1 day before up to 4 days after admission) |
| Measure | Description | Time Frame |
|---|---|---|
| All-cause mortality | 6-months after intensive care admission | |
| All-cause mortality | 28-days after intensive care admission | |
| All-cause mortality | 60-days after intensive care admission | |
| All-cause mortality | 90-days after intensive care admission | |
| All-cause mortality | From admission to the intensive care unit untill discharge from the intensive care unit, an average of two weeks | |
| All-cause mortality | From admission to the intensive care unit untill discharge from the hospital, an average of one month |
| Measure | Description | Time Frame |
|---|---|---|
| Percentage of patients discharged to home | After discharge from the hospital, on average after one month | |
| Length of hospital stay (days) | The total duration of admission to the hospital, an average of one month |
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Inclusion Criteria:
Exclusion Criteria:
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Patients admitted to the intensive care unit
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| Name | Affiliation | Role |
|---|---|---|
| Peter J. Weijs, PhD | Amsterdam UMC, location VUmc | Study Director |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25499096 | Background | Weijs PJ, Looijaard WG, Beishuizen A, Girbes AR, Oudemans-van Straaten HM. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Crit Care. 2014 Dec 14;18(6):701. doi: 10.1186/s13054-014-0701-z. | |
| 24410863 | Result |
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| ID | Term |
|---|---|
| D009133 | Muscular Atrophy |
| D016638 | Critical Illness |
| ID | Term |
|---|---|
| D020879 | Neuromuscular Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D001284 | Atrophy |
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| ID | Term |
|---|---|
| D009752 | Nutritional Status |
| ID | Term |
|---|---|
| D009747 | Nutritional Physiological Phenomena |
| D000066888 | Diet, Food, and Nutrition |
| D010829 | Physiological Phenomena |
| D006304 | Health Status |
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| Nutrition as per hospital protocol | Dietary Supplement | Patients received enteral and/or parenteral nutrition as per usual hospital protocol |
|
| Length of intensive care unit stay | The total duration of admission to the intensive care unit, an average of two weeks |
| Length of ventilation | The total duration of mechanical ventilation during intensive care unit stay, an average of 10 days |
| Weijs PJ, Looijaard WG, Dekker IM, Stapel SN, Girbes AR, Oudemans-van Straaten HM, Beishuizen A. Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients. Crit Care. 2014 Jan 13;18(2):R12. doi: 10.1186/cc13189. |
| 27903267 | Result | Looijaard WG, Dekker IM, Stapel SN, Girbes AR, Twisk JW, Oudemans-van Straaten HM, Weijs PJ. Skeletal muscle quality as assessed by CT-derived skeletal muscle density is associated with 6-month mortality in mechanically ventilated critically ill patients. Crit Care. 2016 Dec 1;20(1):386. doi: 10.1186/s13054-016-1563-3. |
| D020763 |
| Pathological Conditions, Anatomical |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012816 | Signs and Symptoms |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D003710 | Demography |
| D011154 | Population Characteristics |