Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, 12, Beodeunaru-ro 7-gil (Youngdeungpo-dong 2-ga), Youngdeungpo-gu, Seoul 07247, Republic of Korea.
Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, 12, Beodeunaru-ro 7-gil (Youngdeungpo-dong 2-ga), Youngdeungpo-gu, Seoul 07247, Republic of Korea.
Clin Nutr. 2019 Dec;38(6):2763-2769. doi: 10.1016/j.clnu.2018.12.003. Epub 2018 Dec 8.
BACKGROUND & AIMS: Poor outcomes can result from inadequate energy intake. We aimed to investigate the reliability of resting energy expenditure (REE) measured by indirect calorimetry (IC) with REE calculated using predictive equations for nutritional support in patients with major burns.
REE was measured using IC and compared with predictive equations in 215 adult severe burns patients from Jan 2011 to Jun 2015. Agreement between IC and predictive equations was assessed using Bland-Altman methods.
All predictive equations, including newly developed Hangang equation, were compared with REE measured using IC. The mean measured REE was 1712 kcal/d. Bland-Altman analysis showed that 1.2 times HBE, Thumb 25, and Ireton-Jones equations had higher accuracy and reliability. The concordance correlation coefficient was higher (0.49) in the Ireton-Jones equation, and root mean square error (RMSE) was lowest (471.5) in the Thumb 25 equation. The proportion of patients with predicted REE within ±10% of measured REE was highest with Thumb 25 (52.5%). In the validation set, the Hangang equation showed the highest Lin's concordance correlation coefficient (0.67) and the lowest RMSE (311.4). Other equations for burns patients had higher mean bias and overestimated REE when compared with IC results.
This study suggests that Thumb 25 can be used as an alternative method for estimating energy requirements of patients with major burns when IC is not available or applicable. However, for these patients with significant variation in metabolism over time, an alternative equation is the new Hangang equation.
能量摄入不足可能导致不良预后。本研究旨在探讨间接测热法（IC）测量的静息能量消耗（REE）与用于严重烧伤患者营养支持的预测方程之间的可靠性。
2011 年 1 月至 2015 年 6 月，我们对 215 例成年严重烧伤患者进行了研究，使用 IC 测量 REE，并与预测方程进行比较。采用 Bland-Altman 方法评估 IC 与预测方程之间的一致性。
所有预测方程，包括新开发的 Hangang 方程，均与 IC 测量的 REE 进行了比较。测量的平均 REE 为 1712kcal/d。Bland-Altman 分析显示，1.2 倍 HBE、Thumb 25 和 Ireton-Jones 方程具有更高的准确性和可靠性。Ireton-Jones 方程的一致性相关系数更高（0.49），Thumb 25 方程的均方根误差（RMSE）最低（471.5）。预测 REE 与测量 REE 的差值在±10%范围内的患者比例以 Thumb 25 最高（52.5%）。在验证组中，Hangang 方程的 Lin 一致性相关系数最高（0.67），RMSE 最低（311.4）。与 IC 结果相比，其他烧伤患者的预测方程平均偏差更大，REE 高估。
本研究表明，当无法或不适宜使用 IC 时，Thumb 25 可作为严重烧伤患者估计能量需求的替代方法。然而，对于代谢随时间变化较大的这些患者，替代方程是新的 Hangang 方程。
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