O029 - BODY COMPOSITION-BASED INDIVIDUALISED PROTEIN DOSING IN CRITICALLY ILL PATIENTS: THE PROGRESS-ICU STUDY

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O029

BODY COMPOSITION-BASED INDIVIDUALISED PROTEIN DOSING IN CRITICALLY ILL PATIENTS: THE PROGRESS-ICU STUDY

M. C. Paulus1,2, F. Hajeer1,2, A. R. Van Zanten1,2,*

1Intensive Care, Gelderse Vallei Hospital, Ede, 2Human Nutrition & Health, Wageningen University & Research, Wageningen, Netherlands

 

Rationale: To determine whether fat-free mass (FFM)-adjusted protein dosing improves outcomes compared with total body weight (TBW)-based dosing in intensive care unit (ICU) patients.

Methods: Adult ICU patients (April 2020-October 2025) with serial bioelectrical impedance analysis were included in the PROGRESS-ICU observational cohort study. Patients received either TBW-based protein dosing (1.5 g/kg/day; April 2020-June 2023) or FFM-based dosing after protocol revision (1.85 g/kg/day dry FFM, corrected for fluid overload; July 2023 onward). The primary outcome was 90-day all-cause mortality. Secondary outcomes included 30-day mortality, ICU and hospital length of stay, invasive mechanical ventilation (IMV) duration, and longitudinal changes in FFM and urea-to-creatinine ratio (UCR). Survival was analysed with multivariable Cox models and inverse probability weighting; longitudinal outcomes were assessed using mixed-effects models.

Results: Among 620 patients (310 per strategy), median age was 69 years and ~60% were male. Thirty- and 90-day mortality did not differ between groups (adjusted 90-day HR 0.78 [0.56–1.09], p = 0.145).  However, the FFM-based group had a shorter ICU stay (HR 0.79 [0.69–0.91], p < 0.001) and fewer IMV days (HR 0.79 [0.65–0.96], p = 0.019), while hospital stay was similar (HR 0.86 [0.67–1.10], p = 0.237). TBW-based dosing was associated with higher UCR trajectories and greater FFM loss, particularly in women; a preliminary U-shaped protein-mortality association was observed in women only. 

Conclusion: Although FFM-based protein dosing did not reduce mortality, it was associated with improved clinical and metabolic outcomes, supporting further evaluation of body composition-guided protein dosing in critical illness.

Disclosure of Interest: None declared