Strengths of the study
immune dysfunction, disease deterioration
One of the strengths of our study is the design of the trial. In the medical ICU, the time between disease deterioration and admission to the ICU may vary widely. Therefore, the metabolic status of patients may differ greatly from one study to another and may be responsible for introducing heterogeneity within the study. To avoid this shortcoming, we selected only patients who had a time from symptom onset to enrollment less than five days, allowing us to select only patients who were not at risk of hospital-acquired denaturation and immune dysfunction before study enrollment [