Resting Energy Expenditure and Substrate Metabolism in Patients With Acute-on-chronic Hepatitis B Liver Failure.

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J Clin Gastroenterol. 2011 Mar 18. [Epub ahead of print]

Resting Energy Expenditure and Substrate Metabolism in Patients With

Acute-on-chronic Hepatitis B Liver Failure.

Meng QH, Hou W, Yu HW, Lu J, Li J, Wang JH, Zhang FY, Zhang J, Yao QW, Wu J,

Wang X, Liu Y.

*Department of Hepatology, Beijing You An Hospital, Capital Medical University,

Beijing †Alberta Institute for Human Nutrition, University of Alberta, Edmonton,

Canada ‡Public Health Institute, Jilin University, Jilin, China.

Abstract

GOALS: This study was designed to characterize the energy metabolism in the

patients with acute-on-chronic liver failure (ACLF).

BACKGROUND: Protein-energy malnutrition usually occurs in the patients with

chronic liver disease and is exacerbated during the progression of liver

failure. Unfortunately, there is limited study to fully elucidate the energy

metabolism in the patients with ACLF.

STUDY: A retrospective cohort was designed with a total of 282 patients (100

patients with ACLF, 100 with liver cirrhosis, and 82 with chronic hepatitis .

Resting energy expenditure and the oxidation rates of glucose, lipid, and

protein were assessed by indirect heat measurement using the critical care

monitor and desktop analysis system, nutritive metabolic investigation system.

Survival rate was estimated with the Kaplan-Meier method.

RESULTS: There was no significant difference in resting energy expenditure among

the patients with ACLF, the liver cirrhosis, and the chronic hepatitis

(1402.05±480.07 kcal/d in patients with ACLF, 1274.27±316.36 kcal/d in patients

with liver cirrhosis, and 1396.77±384.80 kcal/d in patients with chronic

hepatitis). Respiratory quotient (RQ) was significantly lower in the patients

with ACLF than those in the liver cirrhosis and the chronic hepatitis B

(P=0.000). In patients with ACLF, RQ of the nonsurvival group was significantly

lower than the survival group (P=0.000). It is identified from receiver

operating characteristic curve analysis that a RQ cutoff value of 0.83 (area

under the receiver operating characteristic curve, 0.760) is favorable to

predict good prognosis in patients with liver failure, which has a sensitivity

of 73.68%, a specificity of 74.42%, and positive predictive value of 79.2% and

negative predictive value of 68.1%.

CONCLUSIONS: In patients with ACLF, RQ was significantly lower in the

nonsurvival group than the survival group, thus suggesting that RQ may be used

as an indicator of prognosis of liver failure.

PMID: 21422948 [PubMed - as supplied by publisher]