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Accuracy of predictive equations for resting energy expenditure estimation in mechanically ventilated Thai patients

Napplika Kongpolprom
Napplika Kongpolprom
   | 07. Aug. 2023
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Article Category: Brief Communication (Original)
Online veröffentlicht: 07. Aug. 2023
Seitenbereich: 30 - 38
DOI: https://doi.org/10.2478/abm-2023-0041
Schlüsselwörter
© 2023 Napplika Kongpolprom, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1.

Flow of participants.
Flow of participants.

Figure 2.

Accuracy of predictive equations for estimating REE in obese and non-obese patients. REE, resting energy expenditure.
Accuracy of predictive equations for estimating REE in obese and non-obese patients. REE, resting energy expenditure.

Figure 3.

Bland–Altman plots of differences between predictive REE calculated by 14 equations and measured REE (predictive REE – measured REE) in 24 mechanically ventilated Thai patients. The solid lines at the middle part of each picture represent mean differences of compared values and the upper and lower solid lines represent upper and lower limits of agreement (LOA) (±1.96 SD from mean). The points on these plots non-uniformly and widely scatter around mean differences, indicating poor agreement and bias. REE, resting energy expenditure; SD, standard deviation.
Bland–Altman plots of differences between predictive REE calculated by 14 equations and measured REE (predictive REE – measured REE) in 24 mechanically ventilated Thai patients. The solid lines at the middle part of each picture represent mean differences of compared values and the upper and lower solid lines represent upper and lower limits of agreement (LOA) (±1.96 SD from mean). The points on these plots non-uniformly and widely scatter around mean differences, indicating poor agreement and bias. REE, resting energy expenditure; SD, standard deviation.

Accuracy of predictive equations

Equations n Accurate prediction (%) Under estimation (%) Over estimation (%) Bias (%) Difference(Predictive value – measured value) (kcal/d)
Mean Minimum Maximum
ACCP 30 23.3 60.0 16.7 −13.0 −320 −1257 617
HBE 30 30.0 60.0 10.0 −4.0 −99 −1063 930
1.2×HBE 30 31.8 21.3 40.9 3.2 −49 −742 631
1.5×HBE 30 18.2 9.1 72.7 29.0 322 −476 979
MSJ 30 33.3 50.0 16.7 −10.8 −200 −1172 919
Ireton-Jones 1992 30 6.7 23.3 70.0 22.2 233 −812 923
Ireton-Jones 2002 30 26.7 23.3 50.0 8.0 43 −1018 665
Penn State 2003 (HBE) 24 25.0 50.0 25.0 1.6 −88 −740 837
Penn State 2003 (MSJ) 27 37.0 22.2 40.7 9.6 100 −502 1056
Penn State 2010 27 48.1 14.8 37.0 11.6 98 −472 1089
Swinamer 1990 27 18.5 11.1 70.4 25.9 295 −336 1191
Faisy equation 27 25.9 0.0 74.1 31.8 366 −176 1397
Brandi 1999 22 22.7 27.3 50.0 13.6 74 −549 1115
25 kcal/kg 30 30.0 20.0 50.0 25.2 440 −933 4030

The ICC of 14 equations

Equations (n = 22) ICC 95% Confidence interval
 F test
Lower bound Upper bound
ACCP 0.324 −0.338 0.692 0.136
HBE 0.608 −0.023 0.845 0.003
1.2×HBE 0.764 0.430 0.902 <0.001
1.5×HBE 0.686 0.017 0.886 <0.001
MSJ 0.809 0.515 0.923 <0.001
Ireton-Jones 1992 0.723 0.204 0.894 <0.001
Ireton-Jones 2002 0.800 0.519 0.917 <0.001
Penn State 2003 (HBE) 0.672 0.217 0.863 0.007
Penn State 2003 (MSJ) 0.843 0.626 0.934 <0.001
Penn State 2010 0.814 0.561 0.922 <0.001
Swinamer 1990 0.715 0.155 0.893 <0.001
Faisy equation 0.643 −0.123 0.873 <0.001
Brandi 1999 0.608 −0.104 0.859 0.039
25 kcal/kg 0.701 0.295 0.875 0.002

Predictive equations for REE

Equations Formula
ACCP equation = 25 × weightIf BMI is in the range of 16–25 kg/m2, use usual BWIf BMI > 25 kg/m2, use IBWIf BMI < 16 kg/m2, use existing BW for the first 7–10 d, and then use IBW
HBE Men: kcal/d = 66.47 + 13.75 (w) + 5 (h) − 6.75 (a)Women: kcal/d = 655.1 + 9.56 (w) + 1.85 (h) − 4.68 (a)w = actual weight (kg); but if >125% IBW, use ABWABW = [(actual body weight − IBW) × (0.25 to 0.5)] + IBW
MSJ equation Men: kcal/d = 10 (w) + 6.25 (h) − 5 (a) + 5Women: kcal/d = 10 (w) + 6.25 (h) − 5 (a) − 161
Ireton-Jones 1992 equation 1925 − 10 (a) + 5 (w) + 281 (S) + 292 (T) + 851 (B)
Ireton-Jones 2002 equation 1784 − 11 (a) + 5 (w) + 244 (S) + 239 (T) + 804 (B)
Penn State 2003 equation Harris–Benedict: kcal/d = 0.85 (HBE) + 175 (Tmax) + 33 (Ve) − 6433Mifflin: kcal/d = 0.96 (MSJ) + 167 (Tmax) + 31 (Ve) − 6212
Penn State 2010 equation MSJ (0.71) + Ve (64) + Tmax (85) − 3085
Swinamer 1990 equation (945 × BSA) − (6.4 × age) + (108 × BT) + (24.2 × RR) + (817 × VT) − 4349
Faisy equation 8 (w) + 14 (h) + 42 (Ve) + 94 (BT) − 4834
Brandi 1999 equation 0.96 (HBE) + 7 (HR) + 48 (Ve) − 702
Equation commonly used in critical illness 25 kcal/kg actual body weight including 1–1.5 g protein/kg

Sensitivity analysis for the accuracy of predictive equations

Equations (n = 22) Accurate prediction (%) Under estimation (%) Over estimation (%) Bias (%) Difference(Predictive value – measured value) (kcal/d)
Mean Minimum Maximum
ACCP 22.7 54.5 22.7 −10.2 −272.4 −1091.0 617.0
HBE 27.3 59.1 13.6 14.02 296.7 −987.1 399.7
1.2×HBE 31.8 27.3 40.9 3.18 −49.1 −742.1 631.3
1.5×HBE 18.2 9.1 72.7 29.0 322.3 −475.7 978.6
MSJ 36.4 50.0 13.6 −9.3 −183.3 −773.0 490.8
Ireton-Jones 1992 9.1 18.2 72.7 25.0 275.5 −421.0 923.0
Ireton-Jones 2002 22.7 27.3 50.0 8.8 53.4 −662.0 665.0
Penn State 2003 (HBE) 22.7 50.0 27.3 2.6 −76.1 −739.9 837.1
Penn State 2003 (MSJ) 27.3 27.3 45.5 9.6 73.0 −501.7 944.4
Penn State 2010 40.9 18.2 40.9 12.1 82.6 −471.9 1088.6
Swinamer 1990 18.2 13.6 68.2 25.9 276.6 −335.2 1190.8
Faisy equation 27.3 0.0 72.7 32.4 353.5 −176.0 1397.2
Brandi 1999 23.5 29.4 47.1 14.1 61.4 −548.6 1115.4
25 kcal/kg 31.8 18.2 50.0 20.6 318.5 −933.0 1867.0

Correlation and agreement between measured REE and predictive REE

Equations Correlation Spearman rho Bland–Altman
Mean bias SD Lower LOA Mean – 1.96 (SD) Upper LOA Mean + 1.96 (SD)
ACCP 0.445 −320 457 −1217 576
HBE 0.675 −99 464 −1008 810
1.2×HBE 0.566 −49 355 −744 646
1.5×HBE 0.566 322 358 −379 1023
MSJ 0.736 −200 429 −1041 641
Ireton-Jones 1992 0.624 233 427 −603 1070
Ireton-Jones 2002 0.666 43 402 −745 831
Penn State 2003 (HBE) 0.714 −88 367 −807 631
Penn State 2003 (MSJ) 0.767 100 369 −623 823
Penn State 2010 0.771 98 312 −513 709
Swinamer 1990 0.708 295 335 −363 952
Faisy equation 0.778 366 333 −287 1019
Brandi 1999 0.587 74 394 −698 846
25 kcal/kg 0.675 439 1019 −4377 2457

Baseline characteristics of the patients

Baseline characteristics
Sex n (%)
  Male 12 (50)
Age
  Median (years) 64.5 [43.50, 75.50]
Height
  Median (cm) 160 [151.0, 167.0]
Median (kg)
  Median (cm) 62.5 [47.75, 85.50]
BMI n (%) 27 (100)
  Underweight (<18.5 kg/m2) 6 (25)
  Normal (18.5–22.9 kg/m2) 7 (29.2)
  Overweight (23–24.9 kg/m2) 0 (0)
  Obese 1 (25–29.9 kg/m2) 1 (4.2)
  Obese 2 (>30 kg/m2) 10 (41.7)
BSA (Dubois) median (m2) 1.7 [1.46, 1.86]
Cause of respiratory failure n (%)
  Pneumonia 4 (16.7)
  Post ARDS 3 (12.5)
  COPD 2 (8.3)
  Chronic lung disease 1 (4.2)
  Sepsis 2 (8.3)
  Cardiac arrest 1 (4.2)
  Heart failure 2 (8.3)
  Tetanus 1 (4.2)
  Others 8 (33.3)
Ventilator mode n (%)
  Volume control 3 (10)
  Pressure control 6 (20)
  Pressure support 20 (66.7)
  Proportional assist ventilation 1 (3.3)
Measured REE median (kcal/d)
  Total 1553.0 [1126.75, 2065.75]
  Underweight (<18.5 kg/m2) 1044.0 [884.50, 1591.50]
  Normal (18.5–22.9 kg/m2) 1545.0 [1125.75, 1981.00]
  Overweight (23–24.9 kg/m2) –
  Obese 1 (25–29.9 kg/m2) 1475.0 [1475.00, 1475.00]
  Obese 2 (>30 kg/m2) 2043.5 [1525.25, 2329.50]
Average measured calories per actual BW (kcal/kg) 23.5
Average measured calories per BW (kcal/kg) 27
  Use actual BW if BMI <30 kg/m2
  Use adjusted BW if BMI ≥ 30 kg/m2
Average measured calories per IBW (kcal/kg) 29.5
REE calculated by predictive equations median (kcal/d)
  ACCP 1255.0 [1050.00, 1423.00]
  HBE 1180.5 [1078.89, 1518.95]
  1.2×HBE 1424.3 [1292.80, 1752.98]
  1.5×HBE 1780.4 [1615.99, 2191.23]
  MSJ 1250.0 [1012.25, 1522.50]
  Ireton-Jones 1992 1688.0 [1585.00, 2042.25]
  Ireton-Jones 2002 1479.5 [1373.25, 1957.00]
  Penn State 2003 (HBE) 1523.5 [1270.24, 1734.94]
  Penn State 2003 (MSJ) 1516.5 [1182.04, 1905.00]
  Penn State 2010 1542.4 [1310.89, 1846.61]
  Swinamer 1990 1740.0 [1502.28, 2115.50]
  Faisy 1840.4 [1576.60, 2155.20]
  Brandi 1999 1547.3 [1302.86, 1794.43]
  Equation commonly used in critical illness (25 kcal/kg) 1562.5 [1225.00, 2400.00]
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