Metabolic changes associated with malnutrition in the patients with multiple organ failure.

To clarify the metabolic changes associated with malnutrition in the patients with multiple organ failure (MOF), we measured energy expenditure, nitrogen excretion, nonprotein respiratory quotient (NPRQ), caloric intake, and cumulative caloric balance (CCB) in 20 MOF patients (12 survivors and 8 non-survivors). The non-survivors exhibited significantly greater cumulative caloric deficit than the survivors. Metabolic activity tended to decline to normal in the survivors as organ failures were overcome. In the non-survivors, on the contrary, regardless of large caloric deficit hypermetabolism persisted and characteristically followed by the sudden decrease in metabolic activity at the time immediately prior to death. Compared to the survivors, the non-survivors generally exhibited poorer response in metabolic activity and greater NPRQ change to the altered amount of caloric intake. It seemed that protein sparing effect by increased caloric intake was preserved in both the survivors and the non-survivors only with CCB above -5 times basal energy expenditure. These results suggest that persistent hypermetabolism and poor metabolic response to nutritional support are partly responsible for existing organ failures and poor outcome in MOF patients.