Illness Severity by MELD-Na is not Associated with Energy Expenditure in Cirrhotic Liver Transplant Candidates

Purpose: Hypermetabolism contributes to malnutrition incirrhosis and it often goes undetected. Indirect calorimetry is a high-cost, time-consuming tool which is not accessible to many health care institutions. Predictive equations often underestimate true caloric requirements in cirrhosis. The aim of this study was to assess whether illness severity, defined by MELD-Na score, is associated with increases in measured Resting Energy Expenditure (REE) in patients awaiting liver transplantation. We also sought to quantify a stress factor for improved accuracy of predicted energy requirements in this population. Methods: Data from 40 patients awaiting liver transplantation were retrospectively assessed. MELD-Na was calculated from serum markers; measured REE was quantified using a indirect calorimetry; and predicted REE was determined by the Harris-Benedict equation. Results: MELD-Na scores were not associated with measured REE or prevalence of Hypermetabolism. Forty-three percent of patients required a 20-50% addition to predictive estimates to cover their basal metabolic needs. Conclusions: Our findings suggest a stress factor of 1.2 to 1.3 should be considered when predicting caloric requirements of candidates awaiting liver transplantation in the absence of indirect calorimetry. Illness severity by MELD-Na does not appear to be a useful marker in identifying patients who are hypermetabolic and at higher risk of underfeeding. Keywords: End-stage liver disease; Resting energy expenditure; Indirect calorimetry; Nutritional needs; Liver transplantation