Features of energy and protein supply in patients with sepsis: a retrospective observational study

Abstract

INTRODUCTION: Sepsis remains an actual problem of modern medicine. Among other treatment options, timely prescribed optimal nutritional-metabolic support is one of the priority methods of intensive treatment for this category of patients. OBJECTIVE: To study the severity of metabolic dysfunction in sepsis and determine the parameters of optimal substrate supply for this category of patients. MATERIALS AND METHODS: The study included 166 patients with sepsis. We studied the severity of systemic metabolic dysfunction and the impact of various options for energy and protein supply on the course of the disease and its outcome. Energy expenditure and the severity of the catabolic reaction of the body were studied by dynamic evaluation of indicators of indirect calorimetry, actual losses of nitrogen and nitrogen balance. RESULTS: Actual energy expenditure in sepsis reaches its maximum values by the 5–6th day of the disease (33.5 ± 1.8 kcal/kg/day or 2366 ± 126 kcal/day). The average energy consumption in sepsis is 2226 ± 96 kcal/day or 30.9 ± 1.4 kcal/kg/day. Energy supply in sepsis less than 25 kcal/kg/day leads to a significant increase in mortality. Protein losses in sepsis reach their maximum values by the 5–6th day of the disease (1.93 ± 0.12 g/kg/day). The average loss of protein in sepsis is 1.68 ± 0.06 g/kg/day. Protein provision of this category of patients with more than 1.5 g/kg/day contributes to a significant decrease in mortality, relative to patients receiving less protein per day. CONCLUSIONS: Energy supply in the range of 25–35 kcal/kg/day, as well as protein supply of more than 1.5 g/kg/day, significantly contribute to better survival of patients with sepsis.