Resting energy expenditure in patients with pancreatitis

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Abstract
Objective To assess the resting energy-expenditure of hospitalized patients with pancreatitis. Design Prospective, case-referent study. Setting Nutrition support service in a university tertiary care hospital. Patients Patients referred to the Nutrition Support Service with the diagnosis of pancreatitis. Excluded from study entry included those with cancer, obesity (>150% ideal body weight), those measured within 3 postoperative days, or patients requiring ventilator support with an Fio2 of >0.5. Forty-eight patients with either acute pancreatitis (n = 13), chronic pancreatitis (n = 24), acute pancreatitis with sepsis (n = 7), or chronic pancreatitis with sepsis (n = 7) were studied. The two septic groups were combined into a single pancreatitis-with-sepsis group, since no significant differences among measured variables were observed between individual septic groups. Interventions None. Measurements and Main Results Resting energy expenditure was measured by indirect calorimetry and compared with the predicted energy expenditure, as determined by the Harris-Benedict equations. Resting energy expenditure (percent of predicted energy expenditure) was significantly (p < .02) greater for patients with pancreatitis complicated by sepsis (120 ± 11%) compared with the nonseptic chronic pancreatitis group (105 ± 14%). Resting energy expenditure for the nonseptic acute pancreatitis patients (112 ± 17%) was not significantly different from the other groups. The septic pancreatitis group had the largest percentage (82%) of hypermetabolic (resting energy expenditure >110% of predicted energy expenditure) patients, whereas 61% and 33% of the acute and chronic pancreatitis groups were hypermetabolic, respectively (p < .02). Conclusions Resting energy expenditure is variable in patients with pancreatitis (77% to 139% of predicted energy expenditure). The Harris-Benedict equations are an unreliable estimate of caloric expenditure. Septic complications are associated with hypermetabolism and may be the most important factor influencing resting energy expenditure in pancreatitis patients. (Crit Care Med 1991; 19:484)

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