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The following is a summary of “Association between urea trajectory and protein dose in critically ill adults: a secondary exploratory analysis of the effort protein trial (RE-EFFORT),” published in the January 2024 issue of Critical Care by Haines et al.
Researchers started a retrospective study to investigate whether higher urea values over time could explain the potentially harmful treatment effects of higher doses of protein in mechanically ventilated critically ill patients.
They reanalyzed the EFFORT Protein randomized controlled trial, employing Bayesian joint models to assess the association strength of urea with 30-day survival and comprehend the treatment effect of elevated protein doses.
The results showed 1,301 patients in EFFORT Protein, 1,277 of whom were part of this analysis, with 344 deaths recorded at 30 days post-randomization. By day 6, the high protein group showed a median urea increase of 2.1 mmol/L (95% CI 1.1–3.2), rising to 3.0 mmol/L (95% CI 1.3–4.7) by day 12. A twofold surge in urea correlated with an elevated risk of 30-day mortality (HR 1.34, 95% CI 1.21–1.48), adjusted for baseline characteristics such as age, illness severity, renal replacement therapy, and presence of AKI. This link persisted over the 30-day follow-up, adjusting for evolving organ failure.
Investigators concluded that higher urea linked to death in EFFORT Protein trial, urging caution with high-protein diets for critically ill patients.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04799-1
