Analyses of the impact of energy balance on clinical outcomes in patients with severe traumatic brain injury

Abstract

Objective To observe the energy expenditure in severe traumatic brain injury patients,and to assess the impact of cumulative energy balance on clinical outcomes.Methods Using prospective self-controlled study,the changes of energy expenditure in 56 patients with severe traumatic brain injury were measured.Daily energy intake was recorded.Afterwards,energy balance was calculated.The relationship between cumulative energy balance and clinical outcomes was analyzed.Results Mean practical energy intake of all patients was (5966 ± 1973)kJ/d,and mean negative energy balance was (822 ± 314) kJ/d.The negative energy balance was most crucial in first 3 days after administration.Meanwhile,practical energy intake was significantly lower than target energy intake [(3258±1280)kJ vs (5977±976)kJ,P ＜0.05].The practical energy intake was increased with time,and the first 14 days were crucial for development of negative energy balance.On the 7th day after administration,the level of plasma albumin was significantly lower compared with that on 3 rd [(28.0 ±5.5)g/L vs (36.5 ±4.2)g/L,P ＜0.05],and then increased gradually and returned to normal level on 28 days [(36.2 ± 3.2)g/L].Three days after administration,prealbumin[122.8 ± 18.8)mg] was significantly lower than normal level,but elevated rapidly on the 7 th day[(209.8 ±33.6) mg/L,P ＜0.05] and continuously increased till 28 th day[(281.2 ±24.3)mg/L].On the 3 rd day after administration,C-reactive protein [(135.9 ±44.4) mg/L] was significantly higher than normal level; however,it significantly decreased on the 7 th day[(110.2 ± 36.7)mg/L,P ＜0.05],and continuously decreased.Logistic regression analysis showed a strong association of cumulative negative energy balance with infection and upper gastrointestinal bleeding [odds ratio [(OR) of infection was 2.129,95 ％ confidence interval (95％ CI 1.528 to 29.886,P =0.023 ; OR of upper gastrointestinal bleeding was 0.091,95％ CI0.013 to 0.545,P =0.009].Conclusions Cumulative negative energy balance may be correlated with the occurrence of complications of patients with severe traumatic brain injury,early supply of sufficient energy may improve the outcome of patients. Key words: Craniocerebral trauma/therapy; Nutritional support; Critical illness ; Prognosis