O026 - PREDICTORS OF ENERGY EXPENDITURE IN SEPSIS: INSIGHTS FROM A PROSPECTIVE ICU STUDY

O026

PREDICTORS OF ENERGY EXPENDITURE IN SEPSIS: INSIGHTS FROM A PROSPECTIVE ICU STUDY

W. Wasyluk^1,*, R. Fiut², I. Świetlicka³, A. Zwolak¹, J. Jonckheer⁴, W. Dąbrowski⁵

¹Department of Internal Medicine and Internal Medicine in Nursing, ²Department of Clinical Physiotherapy, Medical University of Lublin, ³Department of Biophysics, University of Life Sciences in Lublin, Lublin, Poland, ⁴Department of Intensive Care Medicine, Universitaire Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium, ⁵1st Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland

Rationale: The metabolic response to sepsis is dynamic and heterogeneous. Accurate assessment of energy requirements is crucial for guiding nutritional therapy, yet data on temporal energy expenditure and its determinants in sepsis remain limited.

Methods: In this prospective observational study, mechanically ventilated ICU patients with sepsis were assessed on days 1, 2, 3, 5, and 7. Resting energy expenditure (REE) and respiratory quotient (RQ) were measured using indirect calorimetry. Clinical, biochemical, and nutritional data were collected. Linear mixed-effects models were applied to analyse longitudinal changes and identify predictors of REE and RQ.

Results: Thirty patients were included. REE increased significantly by day 5 (+163.7 kcal/day; p = 0.049), along with rises in the stress coefficient (p = 0.047) and RQ (p = 0.013). Higher body temperature, arterial pH, protein-to-non-protein calorie ratio, and protein intake were associated with higher REE, while elevated lactate and CRRT use predicted lower REE. The stress coefficient correlated positively with REE coverage, protein intake and the protein-to-non-protein calorie ratio, and negatively with non-nutritive energy intake, CRRT and body-mass index. RQ was positively associated with energy intake, REE coverage, and blood glucose levels. Severity scores and inflammatory markers showed no significant associations.

Conclusion: Energy metabolism in sepsis evolves significantly during the first week. Temperature, treatment with CRRT, blood pH, lactate levels, and nutritional treatment strategies are significantly correlated with REE, providing insights for optimising metabolic and nutritional support in septic patients and suggesting directions for future research. Routine assessment using indirect calorimetry is essential to guide tailored nutritional support in critically ill septic patients.

Disclosure of Interest: None declared