The Effects of Higher Protein Intake on Muscle Mass and Clinical Outcomes in Critically Ill Cancer Patients: A Prespecified Per-Protocol Analysis.

BACKGROUND/

OBJECTIVES

The optimal protein dose for critically ill cancer patients, especially for muscle mass preservation and survival, remains unclear. This study evaluated whether a higher protein intake, compared to usual intake, was associated with improved clinical outcomes in this population.

METHODS

This was a prospective analysis of critically ill adult cancer patients admitted to an oncological intensive care unit (ICU). Patients were initially assigned to receive protein prescriptions of either 1.5 or 2.0 g per kilogram per day (g/kg/day), but due to common limitations in achieving prescribed targets in this setting, a prespecified per-protocol analysis was conducted. After three days of exclusive nutritional therapy, patients were reclassified into two groups based on actual protein intake: >1.5 g/kg/day (higher intake group, IG) and ≤1.5 g/kg/day (usual intake group, CG). The primary outcome was muscle mass preservation, measured by quadriceps muscle thickness (QMT) via ultrasound on days 1, 7, and 14. Secondary outcomes included ICU survival, hospital and ICU length of stay, mechanical ventilation duration, dialysis requirement, and 60-day survival.

RESULTS

From June 2019 to September 2023, 117 patients were included. Following the planned interim analysis, the study was stopped after meeting the Pocock criterion for ICU survival (p = 0.0013). After reclassification, 68.4% (n = 80) were in the IG and 31.6% (n = 37) in the CG. ICU stay was similar (both medians 13 days), but the IG had shorter hospital stays [21.0 vs. 27.5 days, p = 0.020], less QMT loss, and improved ICU (HR = 0.31, 95% CI 0.15-0.64), hospital (HR = 0.43, CI 0.23-0.80), and 60-day survival (HR = 0.43, CI 0.23-0.80), along with shorter ventilation duration (HR = 0.54, CI 0.30-0.99).

CONCLUSIONS

Higher protein intake (>1.5 g/kg/day) was associated with better muscle mass preservation and improved clinical outcomes in critically ill cancer patients.