60.08 Use of Indirect Calorimetry in a Cohort of Patients with Enterocutaneous Fistula

Posted on January 31, 2019

S. Bou Zein Eddine1, A. Kamien1, Z. Yin1, C. Trevino1, R. Fritzshall1, A. Stachowiak1, A. Szabo1, J. S. Juern1, J. R. Peschman1, M. A. De Moya1, P. A. Codner1  1Medical College Of Wisconsin,Surgery/ Trauma And Acute Care Surgery,Milwaukee, WI, USA

Introduction:
Nutrition is key in Enterocutaneous Fistula (ECF) management.  Predictive Equations (PE) and Indirect Calorimetry (IC) are used to calculate nutritional needs but do not correlate well to each other. We hypothesize that even though IC is the gold standard, it is difficult to implement logistically and has a weak concordance with PE.

Methods:
The study included a retrospective cohort of all patients aged ≥18 with ECF admitted between January 2011 and April 2016 and a prospective cohort admitted between April 2016 and February 2017. Demographics, comorbidities, surgeries, and fistula output were determined.  A dietitian determined nutritional therapy and caloric requirements at initial consult, hospital discharge, and outpatient using the Mifflin St Jeor (MSJ) equation. The baseline Resting Energy Expenditure from PE (REEPE) and REE from IC (REEIC) was evaluated for both cohorts, the difference was calculated, and the concordance were plotted in a Bland-Altman plot.

Results:
A total of 33 patients were included. In the prospective arm (n=12) mean age was 54.3 (±18.9) and 66.7% were male. In the retrospective arm (n=21), mean age was 53.7 (±18.3) and 66.7% were male. The median equation difference of REEPE from REEIC, was 71.0 kcal/24 h (IQR, -203.0 – 173.5) in the prospective arm and 123.0 kcal/24 h (IQR, -97.0 – 177.0) in the retrospective arm. The concordance correlation coefficient between REEPE and REEIC was 0.541 (95%CI, 0.213, 0.785). The Bland-Altman plot for the concordance between the REEIC and REEPE (Figure 1) had wide limits of agreement.

Conclusion:
Assessing accurate nutritional requirements remains an increasingly challenging clinical problem. There’s a weak to moderate agreement between REEPE and REEIC and the standardization for IC measurements is logistically difficult to perform.