title: Resting energy expenditure and substrate metabolism in patients with acute-on-chronic hepatitis B liver failure.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A retrospective cohort was designed with a total of 282 patients (100 patients with ACLF, 100 with liver cirrhosis, and 82 with chronic hepatitis B). 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.
authors.affiliation: Department of Hepatology, Beijing You An Hospital, Capital Medical University, Beijing, China.
authors.forename: Qing-Hua
authors.initials: QH
authors.lastname: Meng
authors.forename: Wei
authors.initials: W
authors.lastname: Hou
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Yu
authors.forename: Jing
authors.initials: J
authors.lastname: Lu
authors.forename: Juan
authors.initials: J
authors.lastname: Li
authors.forename: Jin-Huan
authors.initials: JH
authors.lastname: Wang
authors.forename: Fen-Yan
authors.initials: FY
authors.lastname: Zhang
authors.forename: Jian
authors.initials: J
authors.lastname: Zhang
authors.forename: Qin-Wei
authors.initials: QW
authors.lastname: Yao
authors.forename: Juan
authors.initials: J
authors.lastname: Wu
authors.forename: Xin
authors.initials: X
authors.lastname: Wang
authors.forename: Ya
authors.initials: Y
authors.lastname: Liu
mesh_terms: D000328:Adult; D001481:Basal Metabolism; D058625:End Stage Liver Disease / Q000378:metabolism*; D005260:Female; D005947:Glucose / Q000378:metabolism; D006509:Hepatitis B / Q000378:metabolism*; D019694:Hepatitis B, Chronic / Q000378:metabolism*; D006801:Humans; D050356:Lipid Metabolism; D008103:Liver Cirrhosis / Q000378:metabolism; D017114:Liver Failure, Acute / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010084:Oxidation-Reduction; D010101:Oxygen Consumption / Q000502:physiology; D011237:Predictive Value of Tests; D011506:Proteins / Q000378:metabolism; D012680:Sensitivity and Specificity; D015996:Survival Rate
chemical_list: D011506:Proteins; D005947:Glucose