title: Hypermetabolism in the Initial Phase of Intensive Care Is Related to a Poor Outcome in Severe Sepsis Patients.
abstract: OBJECTIVE
  To assess the incidence of hypermetabolism, defined as high resting energy expenditure, in severe sepsis ICU patients, and evaluate the suitability of excessive resting energy expenditure (REE) as a risk factor of their clinical outcome.
  
  
  METHODS
  In a single-center, prospective, six-month observational study in China, the measured REE (MREE) was estimated daily using indirect calorimetry (IC) for the first 5 days of ICU admission. The predicted REE (PREE) was determined using the Harris-Benedict equation. ICU severity criteria (APACHE II and SOFA scores), baseline and health characteristics, and laboratory test results, were compared between the hyper-metabolic (MREE/PREE ratio ≥1.3) and the normometabolic (MREE/PREE ratio <1.3) groups, and between the survivor and non-survivor groups, classified according to 28-day mortality.
  
  
  RESULTS
  Of the 62 included ICU patients (age, 57.1 ± 19.5 years), 34 patients (55%) were hypermetabolic. The 28-day mortality rate in the hypermetabolic and normometabolic groups was 35 and 18%, respectively (p < 0.001). The MREE/PREE ratio and C-reactive protein (CRP) plasma concentration were significantly higher in non-survivors than survivors (p = 0.017), and were significantly (p < 0.05) associated with 28-day mortality (ORMREE/PREE = 1.018, 95% CI, 1.010-2.544, p = 0.031 and ORCRP = 1.010, 95% CI, 1.005-2.173, p = 0.025, respectively).
  
  
  CONCLUSIONS
  In critical sepsis patients admitted to ICU, the MREE/PREE ratio may be a valuable evaluation index of the clinical outcome.
authors.forename: Chao
authors.initials: C
authors.lastname: Wu
authors.forename: Xinying
authors.initials: X
authors.lastname: Wang
authors.forename: Wenkui
authors.initials: W
authors.lastname: Yu
authors.forename: Feng
authors.initials: F
authors.lastname: Tian
authors.forename: Sitong
authors.initials: S
authors.lastname: Liu
authors.forename: Pei
authors.initials: P
authors.lastname: Li
authors.forename: Jieshou
authors.initials: J
authors.lastname: Li
authors.forename: Ning
authors.initials: N
authors.lastname: Li
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000465:Algorithms; D001481:Basal Metabolism; D002097:C-Reactive Protein / Q000032:analysis; D002153:Calorimetry, Indirect; D002681:China; D004734:Energy Metabolism; D005260:Female; D005500:Follow-Up Studies; D006786:Hospitals, Urban; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018805:Sepsis / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy; D012720:Severity of Illness Index
chemical_list: D002097:C-Reactive Protein