Statistical analysis plan for the replacing protein via enteral nutrition in a stepwise approach in critically ill patients randomized clinical trial

• Published in: Trials 2024, Vol.25 (1)
• Main Authors: Arabi, Yaseen M, Al-Dorzi, Hasan M, Aldibaasi, Omar, Sadat, Musharaf, Jose, Jesna, Algethamy, Haifa, Al-Fares, Abdulrahman A, Al-Hameed, Fahad, Mady, Ahmed, Kharaba, Ayman, Al Bshabshe, Ali, Maghrabi, Khalid, AlGhamdi, Khalid, Rasool, Ghulam, AlGhamdi, Adnan, Almekhlafi, Ghaleb. A, Chalabi, Jamal, AlHumedi, Haifaa Ibrahim, Sakkijha, Maram Hasan, Alamrey, Norah Khalid, Alaskar, Amjad Sami, Alhutail, Rabeah Hamad, Sifaoui, Kaouthar, Alqahtani, Rakan, Qureshi, Ahmad S, Hejazi, Mohammed Moneer, Arishi, Hatim, AlQahtani, Samah, Ghazi, Amro Mohamed, Baaziz, Saleh T, Azhar, Abeer Othman, Alabbas, Sara Fahad, AlAqeely, Mohammed, AlOrabi, Ohoud, Al-Mutawa, Aliaa, AlOtaibi, Maha, Elghannam, Madiha Fawazy, Almaani, Mohammed, Buabbas, Sarah Fadel, Alfilfil, Wadiah Alawi M, Alshahrani, Mohammed S, Starkopf, Joel, Preiser, Jean-Charles, Perner, Anders, AlMubarak, Jumana Hani, Hazem, Wafa Mansoor, Albrahim, Talal, Al-Dawood, Abdulaziz, Almatroud, Amal, Burrow, Vicki, Al Zayer, Salha, Khan, Haseena Banu, Varela, Afonso, Alodat, Mohamed Ali, Alshayeh, Rayan, AlHarthi, AbdulRehman, Al Qahtani, Naif, AlHejiely, Yasmeen Ayed, AlZahrani, Mada Muzhir, Lhmdi, Mohammed Haddad, AlBakhiet, Nouf, Baguisa, Katrina, Mhawisg, Huda, Alghethamy, Haifa, Khan, Liyakat, Gabr, Moataz, Nuzhat, Shehla, Malabari, Raghad, Shobragi, Kholoud, Asaas, Shaymaa, Bcuizon, Beverly, Anaud, Christine Joy, AlDammad, Munir, Otaif, Yahia, Hakami, Osama, AlHusseini, Arwa, Bashir, Shahinaz, Hefni, Lama, Alamoudi, Samahar, Ansing, Milyn L, Albalawi, Sawsan, Alahmadi, Manar, AlHumaid, Mohammed, Nouri, Samar Talal, Huma, Rozeena, Farhan, Khawla, Hussein, Mohamed, Baji, Olfa, Alerw, Abdulrehman, Johani, Khloud, AlEnezi, Monera, Boudrar, Ismail, Atiq, Rabiah, Junid, Maali, Yusef, Maram, Quadri, Ahmed, Bin Mabkoot, Mona, Alfilfil, Wadiah Alawi, Alkraidees, AbdulRehman Fahad, Asonto, Laila Perlas
• Format: Report
• Language: English
• Subjects: Care and treatment; Critically ill; Enteral feeding; Health aspects; Nutritional aspects; Proteins; Tube feeding
• ISSN: 1745-6215; 1745-6215
• DOI: 10.1186/s13063-024-08105-w

Background The optimal amount and timing of protein intake in critically ill patients are unknown. REPLENISH (Replacing Protein via Enteral Nutrition in a Stepwise Approach in Critically Ill Patients) trial evaluates whether supplemental enteral protein added to standard enteral nutrition to achieve a high amount of enteral protein given from ICU day five until ICU discharge or ICU day 90 as compared to no supplemental enteral protein to achieve a moderate amount of enteral protein would reduce all-cause 90-day mortality in adult critically ill mechanically ventilated patients. Methods In this multicenter randomized trial, critically ill patients will be randomized to receive supplemental enteral protein (1.2 g/kg/day) added to standard enteral nutrition to achieve a high amount of enteral protein (range of 2-2.4 g/kg/day) or no supplemental enteral protein to achieve a moderate amount of enteral protein (0.8-1.2 g/kg/day). The primary outcome is 90-day all-cause mortality; other outcomes include functional and health-related quality-of-life assessments at 90 days. The study sample size of 2502 patients will have 80% power to detect a 5% absolute risk reduction in 90-day mortality from 30 to 25%. Consistent with international guidelines, this statistical analysis plan specifies the methods for evaluating primary and secondary outcomes and subgroups. Applying this statistical analysis plan to the REPLENISH trial will facilitate unbiased analyses of clinical data. Conclusion Ethics approval was obtained from the institutional review board, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia (RC19/414/R). Approvals were also obtained from the institutional review boards of each participating institution. Our findings will be disseminated in an international peer-reviewed journal and presented at relevant conferences and meetings. Trial registration ClinicalTrials.gov, NCT04475666. Registered on July 17, 2020. Keywords: Critical illness, Protein, Statistical analysis plan, Randomized clinical trial, Nutrition