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Publication Details

Title :

Permissive underfeeding, cytokine profiles and outcomes in critically ill patients

Journal:

PLoS One.

Impact Factor:

2.766

Authors:

Arabi Y1, Jawdat D2, Bouchama A3, Tamim H4, Tamimi W5, Al-Balwi M5, Al-Dorzi HM1, Sadat M1, Afesh L1, Abdullah ML3, Mashaqbeh W2, Sakhija M1, Hussein MA6, ElObeid A7, Al-Dawood A1.

Affiliations:

1 Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

2 Cord Blood Bank, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

3 Department of Experimental Medicine, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

4 Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.

5 Department of Clinical Laboratory, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

6 Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

7 Department of Biobank, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Address reprint requests to Dr. Arabi at the Intensive Care Department, Ministry of National Guard Health Affairs, ICU 1425, P.O. Box 22490, Riyadh 11426, Saudi Arabia, or at arabi@ngha.med.sa.

Year of Publication:

2019

DOI:

10.1371/journal.pone.0209669

Abstract:

BACKGROUND: During critical illness in humans, the effects of caloric restriction on the inflammatory response are not well understood. The aim of this study is to examine the associations of caloric restriction, inflammatory response profiles and outcomes in critically ill patients.

METHODS: This is a sub-study of the PermiT trial (Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults Trial- ISRCTN68144998). Serum samples were collected on study days 1, 3, 5, 7 and 14 and analyzed for a panel of 29 cytokines. We used principal component analysis to convert possibly correlated variables (cytokine levels) into a limited number of linearly uncorrelated variables (principal components). We constructed repeated measures mixed linear models to assess whether permissive underfeeding compared to standard feeding was associated with difference cytokine levels over time.

RESULTS: A total of 72 critically ill patients were enrolled in this study (permissive underfeeding n = 36 and standard feeding n = 36). Principal component analysis identified 6 components that were responsible for 78% of the total variance. When adjusted to principal components, permissive underfeeding was not associated with 90-day mortality (adjusted odds ratio 1.75, 95% confidence interval 0.44, 6.95, p = 0.43) or with incident renal replacement therapy. The cytokines did not differ with time between permissive underfeeding and standard feeding groups.

CONCLUSIONS: The association of permissive underfeeding compared to standard feeding with mortality was not influenced by the inflammatory profile. Permissive underfeeding compared to standard feeding was