In Reply We disagree with Drs Buijs and van Leeuwen that the observed signal of increased 6-month mortality among patients treated with IMHP compared with HP is misleading.
The MetaPlus study was designed to observe a 50% relative reduction in incidence of new infections, from an incidence of 25% to 12.5% in the control group (absolute reduction, 12.5%), based on a meta-analysis described in the article. The actual incidence of infections was larger than estimated (53% in the IMHP group and 52% in the HP group). Therefore the study was not underpowered to detect differences in infections. Even though the incidence of infections was higher than estimated, we did not observe any reduction of infectious morbidity.
Arthur R. H. van Zanten, Zandrie Hofman. Standard vs Enriched High Protein Enteral Nutrition in the ICU—Reply. JAMA. 2014;312(21):2288–2289. doi:10.1001/jama.2014.14499