Predictive energy equations are inaccurate for determining energy expenditure in adult burn injury: a retrospective observational study

James Leung, Emma J. Ridley, Heather Cleland, Joshua F. Ihle, Eldho Paul, Susannah J. King

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Severe burn injuries are associated with hypermetabolism. This study aimed to compare the measured energy expenditure (mEE) with predicted energy requirements (pERs), and to correlate energy expenditure (EE) with clinical parameters in adults with severe burn injury. Methods: Data were retrospectively analysed on 29 burn patients (median (interquartile range) age: 46 (28–61) years, % total body surface area burn: 37% (18–46%)) admitted to an intensive care unit. Indirect calorimetry was performed on 1–4 occasions per patient to measure EE. mEE was compared with pER calculated using four prediction equations. Bland–Altman and correlation analyses were performed. Results: Mean ± SD mEE was 9752 ± 2089 kJ/day (143 ± 32% of predicted basal metabolic rate). Bland–Altman analysis demonstrated clinically important overestimation for three of the four prediction equations and wide 95% limits of agreement for all equations. Overestimation of EE was more marked early post-burn. mEE correlated with day post-burn (r = 0.42, P = 0.004) and number of operations prior to first EE measurement (r = 0.34, P = 0.016), but not with % total body surface area (r = 0.02, P = 0.9). Conclusions: Patients with severe burn injury exhibit hypermetabolism. The observed poor agreement between pER and mEE at an individual level indicates the value of indirect calorimetry in determining EE in burn injury.

Original languageEnglish
Pages (from-to)578-583
Number of pages6
JournalANZ Journal of Surgery
Volume89
Issue number5
DOIs
Publication statusPublished - 1 May 2019

Keywords

  • burn injury
  • energy metabolism
  • indirect calorimetry
  • intensive care
  • nutrition

Cite this

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title = "Predictive energy equations are inaccurate for determining energy expenditure in adult burn injury: a retrospective observational study",
abstract = "Background: Severe burn injuries are associated with hypermetabolism. This study aimed to compare the measured energy expenditure (mEE) with predicted energy requirements (pERs), and to correlate energy expenditure (EE) with clinical parameters in adults with severe burn injury. Methods: Data were retrospectively analysed on 29 burn patients (median (interquartile range) age: 46 (28–61) years, {\%} total body surface area burn: 37{\%} (18–46{\%})) admitted to an intensive care unit. Indirect calorimetry was performed on 1–4 occasions per patient to measure EE. mEE was compared with pER calculated using four prediction equations. Bland–Altman and correlation analyses were performed. Results: Mean ± SD mEE was 9752 ± 2089 kJ/day (143 ± 32{\%} of predicted basal metabolic rate). Bland–Altman analysis demonstrated clinically important overestimation for three of the four prediction equations and wide 95{\%} limits of agreement for all equations. Overestimation of EE was more marked early post-burn. mEE correlated with day post-burn (r = 0.42, P = 0.004) and number of operations prior to first EE measurement (r = 0.34, P = 0.016), but not with {\%} total body surface area (r = 0.02, P = 0.9). Conclusions: Patients with severe burn injury exhibit hypermetabolism. The observed poor agreement between pER and mEE at an individual level indicates the value of indirect calorimetry in determining EE in burn injury.",
keywords = "burn injury, energy metabolism, indirect calorimetry, intensive care, nutrition",
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Predictive energy equations are inaccurate for determining energy expenditure in adult burn injury : a retrospective observational study. / Leung, James; Ridley, Emma J.; Cleland, Heather; Ihle, Joshua F.; Paul, Eldho; King, Susannah J.

In: ANZ Journal of Surgery, Vol. 89, No. 5, 01.05.2019, p. 578-583.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Predictive energy equations are inaccurate for determining energy expenditure in adult burn injury

T2 - a retrospective observational study

AU - Leung, James

AU - Ridley, Emma J.

AU - Cleland, Heather

AU - Ihle, Joshua F.

AU - Paul, Eldho

AU - King, Susannah J.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background: Severe burn injuries are associated with hypermetabolism. This study aimed to compare the measured energy expenditure (mEE) with predicted energy requirements (pERs), and to correlate energy expenditure (EE) with clinical parameters in adults with severe burn injury. Methods: Data were retrospectively analysed on 29 burn patients (median (interquartile range) age: 46 (28–61) years, % total body surface area burn: 37% (18–46%)) admitted to an intensive care unit. Indirect calorimetry was performed on 1–4 occasions per patient to measure EE. mEE was compared with pER calculated using four prediction equations. Bland–Altman and correlation analyses were performed. Results: Mean ± SD mEE was 9752 ± 2089 kJ/day (143 ± 32% of predicted basal metabolic rate). Bland–Altman analysis demonstrated clinically important overestimation for three of the four prediction equations and wide 95% limits of agreement for all equations. Overestimation of EE was more marked early post-burn. mEE correlated with day post-burn (r = 0.42, P = 0.004) and number of operations prior to first EE measurement (r = 0.34, P = 0.016), but not with % total body surface area (r = 0.02, P = 0.9). Conclusions: Patients with severe burn injury exhibit hypermetabolism. The observed poor agreement between pER and mEE at an individual level indicates the value of indirect calorimetry in determining EE in burn injury.

AB - Background: Severe burn injuries are associated with hypermetabolism. This study aimed to compare the measured energy expenditure (mEE) with predicted energy requirements (pERs), and to correlate energy expenditure (EE) with clinical parameters in adults with severe burn injury. Methods: Data were retrospectively analysed on 29 burn patients (median (interquartile range) age: 46 (28–61) years, % total body surface area burn: 37% (18–46%)) admitted to an intensive care unit. Indirect calorimetry was performed on 1–4 occasions per patient to measure EE. mEE was compared with pER calculated using four prediction equations. Bland–Altman and correlation analyses were performed. Results: Mean ± SD mEE was 9752 ± 2089 kJ/day (143 ± 32% of predicted basal metabolic rate). Bland–Altman analysis demonstrated clinically important overestimation for three of the four prediction equations and wide 95% limits of agreement for all equations. Overestimation of EE was more marked early post-burn. mEE correlated with day post-burn (r = 0.42, P = 0.004) and number of operations prior to first EE measurement (r = 0.34, P = 0.016), but not with % total body surface area (r = 0.02, P = 0.9). Conclusions: Patients with severe burn injury exhibit hypermetabolism. The observed poor agreement between pER and mEE at an individual level indicates the value of indirect calorimetry in determining EE in burn injury.

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KW - energy metabolism

KW - indirect calorimetry

KW - intensive care

KW - nutrition

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SP - 578

EP - 583

JO - ANZ Journal of Surgery

JF - ANZ Journal of Surgery

SN - 1445-1433

IS - 5

ER -