Hypermetabolism in clinically stable patients with liver cirrhosis

Hypermetabolism in clinically stable patients with liver cirrhosis

Manfred J Müller, Joachim Böttcher, Oliver Selberg et al.                                                                                Am J Clin Nutr 1999;69:1194-201

BACKROUND: Hypermetabolism has a negative effect on prognosis in patients with liver cirrhosis. Its exact prevalence and associations with clinical data, the nutritional state, and b-adrenergic activity are unclear.
OBJECTIVE: We investigated resting energy expenditure (REE) in 473 patients with biopsy-proven liver cirrhosis.
DESIGN: This was a cross-sectional study with a controlled intervention (b-blockade) in a subgroup of patients.
RESULTS: Mean REE was 7.12 ± 1.34 MJ/d and correlated closely with predicted values (r = 0.70, P < 0.0001). Hypermetabolism was seen in 160 patients with cirrhosis (33.8% of the study population). REE was > 30% above the predicted value in 41% of the hypermetabolic patients wirh cirrhosis. Hypermetabolism had no association with clinical or biochemical data on liver function. REE correlated with total body potassium content (TBP; r = 0.49, P < 0.0001). Hypermetabolic patients had lower than normal body weight and TBP (P < 0.05). About 47% of the variance in REE could be explained by body composition whereas clinical state could maximally explain 3%. Plasma epinephrine and norepinephrine concentrations were elevated in hypermetabolic cirrhotic patients (by 56% and 41%, respectively; P< 0.001 and 0.01). Differences in REE from predicted values were positively correlated with epinephrine concentration (r = 0.462, P < 0.001). Propranolol infusion resulted in a decrease in energy expenditure (by 5 ± 3%; P < 0.05), heart rate (by 13 ± 4%; P < 0.01), and plasma lactate concentrations (by 32 ± 12%; P < 0.01), and plasma lactate concentrations (by 32 ± 12%; P < 0.01); these effects were more pronounced in hypermetabolic patients (by 50%, 33%, and 68%, respectively; each P < 0.05).
CONCLUSIONS: Hypermetabolism has no association with clinical data and thus is an extrahepatic manifestation of liver disease. Increased b-adreneric activity may explain ~25% of hypermetabolism.