Hypermetabolism in the Initial Phase of Intensive Care Is Related to a Poor Outcome in Severe Sepsis Patients

Abstract

Objective: To assess the incidence of hypermetabolism, defined as high resting energy expenditure, in severe sepsis ICU patients, and evaluate the suitability of excessive resting energy expenditure (REE) as a risk factor of their clinical outcome. Methods: In a single-center, prospective, six-month observational study in China, the measured REE (MREE) was estimated daily using indirect calorimetry (IC) for the first 5 days of ICU admission. The predicted REE (PREE) was determined using the Harris-Benedict equation. ICU severity criteria (APACHE II and SOFA scores), baseline and health characteristics, and laboratory test results, were compared between the hyper-metabolic (MREE/PREE ratio ≥1.3) and the normometabolic (MREE/PREE ratio <1.3) groups, and between the survivor and non-survivor groups, classified according to 28-day mortality. Results: Of the 62 included ICU patients (age, 57.1 ± 19.5 years), 34 patients (55%) were hypermetabolic. The 28-day mortality rate in the hypermetabolic and normometabolic groups was 35 and 18%, respectively (p < 0.001). The MREE/PREE ratio and C-reactive protein (CRP) plasma concentration were significantly higher in non-survivors than survivors (p = 0.017), and were significantly (p < 0.05) associated with 28-day mortality (OR_{MREE/ PREE} = 1.018, 95% CI, 1.010-2.544, p = 0.031 and OR_CRP = 1.010, 95% CI, 1.005-2.173, p = 0.025, respectively). Conclusion: In critical sepsis patients admitted to ICU, the MREE/PREE ratio may be a valuable evaluation index of the clinical outcome.

Hiperglicemia por sepsis: del mecanismo a la clínica

“…La respuesta predominante del organismo es un estado de hiperglicemia e insulino-resistencia 11 . Este estado hipermetabólico se asocia a aumento de la mortalidad atribuible en parte a la hiperglicemia causada por la mayor producción endógena de glucosa y a la presencia de insulino-resistencia; se relaciona estrechamente con la severidad de la enfermedad crítica, índice de masa corporal y gasto energético en reposo 7 .…”

Persistently Increased Resting Energy Expenditure Predicts Short-Term Mortality in Patients with Acute-on-Chronic Liver Failure

“…A longitudinal study showed that hypermetabolism in cirrhotic patients is associated with poor prognosis independent of MELD scores [10]. Similarly, hypermetabolism increases the 28-day mortality in critical sepsis patients [11]. Based on these studies, we hypothesized that hypermetabolism might predict the poor clinical outcome of HBV-ACLF patients, we thus measured energy metabolism in these patients.…”

Energy metabolism in amyotrophic lateral sclerosis: assessment of body composition and energy expenditure

“…In severe burns, hypermetabolism is associated with significant catabolism of skeletal muscle (Newsome et al, 1973, Hart et al, 2000 and, diminished mitochondrial coupling in skeletal muscle (Porter et al, 2016) and brown adipose tissue (Yo et al, 2013). In extreme cases, hypermetabolism can be life threatening and require critical care (Wu et al, 2015a).…”

“…It has recently been shown that hypermetabolism correlates with clinical and biological markers of cancer cachexia and is associated with a shorter survival in metastatic cancer patients (Vazeille et al, 2017). Hypermetabolism in patients with severe sepsis in ICU predicts a worse mortality (Wu et al, 2015a). Similarly hypermetabolism following severe burns is associated with increased cardiac workload, muscle wasting and increased morbidity (Herndon et al, 2001).…”

“…Although a causal relationship between hypermetabolism and survival has not been confirmed in ALS, hypermetabolism is known to predict a shorter survival in other disorders including cancer (Vazeille et al, 2017), sepsis (Wu et al, 2015a) and burns (Herndon et al, 2001). Evidence from dietary studies in ALS suggests that hypermetabolism and survival could be linked.…”