127 PROTEIN PROVISION AND EXERCISE THERAPY TO IMPROVE OUTCOMES IN ICU-SURVIVORS 7 requirements), which resulted in a mean difference in protein delivery of 0.38 - 0.74g/kg/day and 37.0 - 38.3g/day. Energy delivery varied from -0.4 - 2.8kcal/ kg/day and -26 - 430.3kcal/day. Overall, the results show that protein delivery is below theminimumprotein recommendation of 1.2g/kg/day in the comparator group. Three studies reported equal energy delivery between the intervention and comparator group while delivering significantly different amounts of protein.46,50,58 Other studies showed that increased protein delivery was accompanied by increased energy delivery in favour of the intervention group.46,47,54 7.3.8 Effects of protein provision on mortality Table S5 (Appendix 2) presents a total of six eligible non-randomised studies that reported mortality as an outcome measure at different time points (28-, 60-, 90-, 180-days, in ICU or hospital, and at six months).48,49,52,56,59,60 Cut-off points in protein delivery between intervention and comparator groups varied across studies, next to different strategies in the analysis concerning controlling for relevant confounders. Most controlled variables in the analysis were age, SOFA score, APACHE-II score, BMI, and ICU-admission category. Both decreased and increased risks of mortality were seen when delivering more protein. A statistically significant decreased risk was seen in four studies, with adjusted OR and HR between 0.60-0.68 and 0.48-0.90 respectively.48,49,52,60 A statistically significant increased risk of mortality (HR 1.495 and 3.65) when delivering more protein was seen in two studies.59,60. Jeong et al48 reported a statistically significant decreased risk of mortality in a subgroup of patients at high risk of malnutrition receiving ≥1.2g protein/kg/day (HR 0.50; CI [0.28; 0.90]). 7.3.9 Effects of combined protein-exercise therapy on quality of life, physical functioning, and muscle health One study reported the effects of combined protein-exercise therapy on QoL, physical functioning, and muscle health (Table 2).57 No statistically significant effect was seen on the QoL (MD 1.3, CI [-1.9; 4.5]) and physical functioning (Barthel Index, MD -2.6, CI [-9.08; 14.28]). The group receiving a medium amount of protein combined with rehabilitation and EMS lost significantly more femoral muscle the first ten days (MD -4.6%, CI [0.74; 8.46]) compared to high protein combined with rehabilitation and EMS.
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