Characteristics of energy metabolism in patients with acute liver failure and subacute liver failure

Abstract

Objective To study the characteristics of energy metabolism in patients with acute liver failure (ALF) and subacute liver failure (SALF). Methods Thirteen ALF patients, 23 SALF patients, 20 cases of liver cirrhosis (LC) caused by hepatitis B virus admitted to Beijing Youan Hospital affiliated to Capital Medical University from March 2008 to December 2014, as well as 30 healthy controls (HC) were included in this study. Energy metabolism indexes were measured, including resting energy expenditure (REE), predict resting energy expenditure (pREE), respiratory quotient (RQ), carbohydrate oxidation rate (CHO), fat oxidation rate (FAT) and protein oxidation rate (PRO). Comparison between two groups were conducted by t test. Comparisons among groups were conducted by univariate variance analysis. The qualitative data were analyzed by χ2 test. Results REE in HC group, LC group, ALF group and SALF group were (6 180.05±1 434.68), (5 584.38±1 180.14), (7 107.01±1 641.22) and (6 530.31±1 306.92) kJ/d, respectively (F=3.557, P=0.018). REE/pREE (%) in four groups were (96.77±18.77)%, (88.80±17.71)%, (114.69±29.19)% and (112.48±17.33)%, respectively (F=7.389, P=0.000). RQ in four groups were 0.87±0.04, 0.83±0.06, 0.84±0.06 and 0.79±0.04, respectively (F=10.499, P=0.000). CHO in four groups were (51.53±13.00)%, (39.30±19.09)%, (41.15±20.35)% and (25.04±13.45)%, respectively (F=1.234, P=0.303). FAT in four groups were (37.00±13.99)%, (45.60±19.12)%, (43.85±21.01)%, and (59.39±15.94)%, respectively (F=2.125, P=0.103). PRO in four groups were (11.47±3.47)%, (15.10±4.83)%, (15.00±4.55)% and (15.57±6.88)%, respectively (F=2.338, P=0.080). The onset time of SALF group was (38.17±11.16) days, which was significantly longer than the ALF group of (8.85±3.21) days (t=-11.768, P=0.000). Conclusions REE and REE/pREE both increase in ALF and SALF patients, showing a hypermetabolic status. Nutrient metabolic disorder in SALF patients is more severe compared to ALF patients, characterized as a reduced RQ, decreased CHO and increased FAT, which may be associated with a longer onset time of disease. Key words: Liver failure; Resting energy expenditure; Respiratory quotient; Carbohydrate oxidation rate