Accuracy of Computed Equations for Predicting the Resting Energy Requirements in Patients with Generalized Secondary Peritonitis

Nutritional support is central to prompt treatment of patients with generalized secondary peritonitis (GSP).
These patients desperately need a simple and affordable solution to evaluate their daily energy need.
Objective: to determine accuracy of estimating the Resting Energy Expenditure (REE) in GSP patients.
Materials and methods. Study design: a prospective, single center study. The inclusion criteria: diagnosed GSP and stay at the Intensive Care Unit (ICU). Three treatment arms were formed. The first arm included all patients (n=61), the second arm included patients capable to breath spontaneously and adequately (n=29), and the third arm included patients on artificial ventilation (n=32). Reference values of REE were calculated by Indirect Calorimetry (IC) method using Engstrom Carestation Lung Ventilator and Metabolic (General Electric,USA). Six equations were used to predict REE values: Ideal Body Weight multiplied by 25 (IBWX25); Actual Body Weight multiplied by 25 (ABWX25); J. A. Harris, F. Benedict (HB); HB with corrective ratio 1.25 (HBX1.25); C. Ireton-Jones, 1992 (IJ); PennState, 2003 equation, in modification (PS). SPSS Software Package was used for statistical analysis of the results. The zero hypothesis was rejected at P<0.05.
Results. In patients with GSP, the REE value determined by means of Indirect Calorimetry method was equal to 25.78±1.37 kcal/kg/day. If compared with Indirect Calorimetry results, predictive accuracy of calculation equations in the second and third arm, respectively, were as follows: IBWX25: 30 and 0%, HB: 36.7 and 9.9%, HBX1.25: 49.9 and 45.5%, IJ: 51.8 and 53.2%, ABWX25: 63.4 and 60.6%, PS (as determined in patients on mechanical ventilation only): 42.4%.
Conclusion. Indirect Calorimetry method is the only accurate way of REE evaluation in GSP patients. ABWX25 and IJ showed the highest predictive accuracy. IBWX25 and HB had the lowest predictive accuracy.

1. Kinney J.M., Jeejeebhoy K.N., Hill G.L., Owen O.E. Nutrition and metabolism in patient care. Philadelphia (PA): Saunders; 1988. DOI: 10.1016/0168-8278 (89)90176-1

2. Weijs P.J., Looijaard W.G., Beishuizen A., Girbes A.R, Straaten H.M. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Crit Care. 2014; 18: 701. DOI: 10.1186/s13054-014-0701-z

3. Klein C.J, Stanek G.S., Wiles C.E. 3rd. Overfeeding macronutrients to critically ill adults: metabolic complications. J Am Diet Assoc. 1998; 98: 795–806. PMID: 9664922. DOI: 10.1016/S0002-8223 (98)00179-5

4. Preiser J.C., van Zanten A.R., Berger M.M., Biolo G., Casaer M.P., Doig G.S., Griffiths R.D., Heyland D.K., Hiesmayr M., Iapichino G., Laviano A., Pichard C., Singer P.,Van den Berghe G.,Wernerman J.,Wischmeyer P., Vincent J.L. Metabolic and nutritional support of critically ill patients: consensus and controversies. Crit Care. 2015; 19 (1): 35. DOI: 10.1186/s13054-015-0737-8. PMID: 25886997. PMCID: PMC4310041.

5. Weijs P.J., Wischmeyer P.E. Optimizing energy and protein balance in the ICU. Curr Opin Clin Nutr Metab Care. 2013; 16: 194–201 PMID: 23334173. DOI: 10.1097/MCO.0b013e32835bdf7e

6. Efremov S.M., Talaban V.O., Artemieva V.V., Deryagin M.N., Lomivorotov V.V. Theory and practice of resting energy expenditures evaluation of the patients in the intensive care departments. Messenger of anesthesiology and resuscitation=Vestnik anesteziologii i reanimatologii. 2016; 13 (4): 61–67. (In Russ.) DOI: 10.21292/2078-5658-201613-4-61-67

7. Compher C., Nicolo M., Chittam, J., Kang Y., Day A. G., Heyland D. K. Clinical Outcomes in Critically Ill Patients Associated With the Use of Complex vs Weight-Only Predictive Energy Equations. Journal of Parenteral and Enteral Nutrition. 2014. 39 (7): 864–869. DOI: 10.1177/0148607114533127

8. Kreymann G., Adolph M., Mueller M.J. Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine. Energy expenditure and energy intake — Guidelines on Parenteral Nutrition, Chapter 3. Ger Med Sci. 2009; 7: Doc25. Published 2009 Nov 18. DOI: 10.3205/000084

9. Harris J. A., Benedict F. A biometric study of basal metabolism in man. Washington DC, Washington DC, 1919. — 284 p.

10. Taylor B.E., McClave S.A., Martindale R.G., Warren M.M., Johnson D.R., Braunschweig C., McCarthy M.S., Davanos E., Rice T.W., Cresci G.A., Gervasio J.M., Sacks G.S., Roberts P.R., Compher C. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) JPEN J Parenter Enteral Nutr. 2016; 40 (2): 159–211. DOI: 10.1097/CCM.0000000000001525

11. Ireton-Jones C.S., Turner W.W., Jr, Liepa G.U., Baxter C.R. Equations for the estimation of energy expenditures in patients with burns with special reference to ventilatory status. J Burn Care Rehabil. 1992; 13: 330–333. PMID: 1618877

12. Frankenfield D., Smith J.S., Cooney R.N. Validation of 2 approaches to predicting resting metabolic rate in critically ill patients. JPEN J Parenter Enteral Nutr. 2004; 28: 259–264. PMID: 15291408. DOI: 10.1177/0148607104028004259

13. Yatabe T., Egi M., Sakaguchi M., Ito T., Inagaki N., Kato H., Kaminohara J., Konishi A., Takahashi M., Tatsumi H., Tobe M., Nakashima I., Nakamoto N., Nishimura T., Nitta M., Nishimura M. Influence of nutritional management and rehabilitation on physical outcome in Japanese intensive care unit patients: a multicenter observational study. Ann Nutr Metab. 2019; 74 (1): 35–43. DOI: 10.1159/000495213

14. Costa N.A., Marinho A.D., Cancado L.R. Nutritional requirements of the critically ill patient. Rev Bras Ter Intensiva. 2012; 24: 270–277.

15. de Goes C.R., Berbel-Bufarah M.N., Sanches A.C., Xavier P.S., Balbi A.L., Ponce D. Poor agreement between predictive equations of energy expenditure and measured energy expenditure in critically ill acute kidney injury patients. Ann Nutr Metab. 2016; 68 (4): 276–284. PMID: 27288392. DOI: 10.1159/000446708

16. Boullata J.,Williams J., Cottrell F., Hudson L., Compher C. Accurate determination of energy needs in hospitalized patients. J Am Diet Assoc. 2007; 107: 393–401. PMID: 17324656. DOI: 10.1016/j.jada.2006.12.014