Энергетическая потребность покоя и экскреция азота с мочой при стрессовой гипергликемии в раннюю фазу острого тяжелого панкреатита

Abstract

Purpose. To investigate the features of resting energy expenditure and urinary nitrogen excretion during stress-induced hyperglycemia at an early phase of acute severe pancreatitis. Materials and methods. The study design was a prospective single-center cohort study. The inclusion criteria were: diagnosed acute pancreatitis and at least one severity predictor. On day one, three, and five the dark blood glycemic index and urinary nitrogen excretion were measured and resting energy expenditure was determined in all patients. From the total number of cases (n = 72), a cohort of patients with severe acute pancreatitis was singled out (n = 23). In that cohort, three groups were formed. The first group included measurements made over the whole observation period (n = 69), the second – normoglycemia (n = 48), and the third one – hyperglycemia. Stress-induced hyperglycemia was determined as increased blood glucose ≥ 11.1 mmol/L. The raw data were statistically processed using SPSS package. The zero hypothesis was rejected at p < 0.05. Results. A statistically significant difference was found between the second and third groups in the glycemia index (p < 0.001) and urinary nitrogen excretion (p = 0.022), but not in the resting energy expenditure (p = 0.157). The prevalence of glycemia among the deceased amounted to 66.6% and among the survived – 17.2%. To make up the quantity of nitrogen lost with urine, the normoglycemia patients required an uptake of 117.1 nonprotein kcal per 1 g of nitrogen, and the hyperglycemia patients -61.7 kcal. Conclusion. At an early phase of acute severe pancreatitis, urinary nitrogen excretion rises in a statistically significant manner in patients with stress-induced hyperglycemia. To make up the urinary nitrogen loss, the normoglycemia patients require 117.1 nonprotein kcal per 1 g of nitrogen while hyperglycemia patients – 61.7.