机械通气的外科危重症患者静息能量消耗评价

目的比较机械通气的外科危重症患者测定的静息能耗(MREE)与校正Harris-Benedict公式计算的静息能耗(CREE)之间的差异,评估静息能耗与疾病严重程度的相关性.方法选取2008年8月至2010年2月符合入选标准的外科危重症患者21例.收集患者相关数据,计算急性生理与既往健康状况评分(APACHEⅡ评分)和器官功能不全评分(Marshall评分).采用美国MedGraphics CCM/D系统间接能耗测量仪测定MREE,采用校正Harris-Benedict公式计算CREE.结果营养支持1周内,21例患者的平均CREE明显高于平均MREE[(8305.09±1392.76)kJ比(6544.84±2079.65) kJ,P=0.000].营养支持当日和第1、2(P均=0.000)、4天(P =0.003)的CREE明显高于MREE.CREE与MREE之间无相关性(r=0.064,P=0.408),MREE与APACHEⅡ评分也无相关性(r=-0.045,P=0.563).MREE与Marshall评分有相关性(P =0.001),但相关系数较低(r=0.263).结论基于病情校正的Harris-Benedict公式明显高估了外科危重症患者的能耗水平,间接能耗仪测定的静息能耗更为准确.     

机械通气危重患儿的连续性静息能量消耗测定

目的　探讨机械通气危重患儿的静息能量消耗变化,比较公式估算与间接测热法（IC）所测得的能量消耗之间的差异,分析影响危重患儿代谢状态的可能因素。方法　前瞻性收集2012年9月至2013年9月入住上海儿童医学中心重症监护室、行呼吸机辅助通气、满足IC要求的内科危重症患儿共56例,于机械通气第1、4、7、10天应用代谢车测定其静息能量消耗,并记录患儿的一般临床资料。结果　对56例患儿行IC测定130次,所测得的静息能量消耗值（MREE）在机械通气第1、4、7、10天间比较差异无统计学意义（P=0.379）。MREE与Schofield及WHO公式估算值（PEE）比较差异虽无统计学意义（P值分别为0.917和0.995）,但一致性较差（R2值分别为0.185和0.322）。患儿在机械通气第1天的代谢状态仅与年龄（P=0.000）和身高（P=0.027）相关,与疾病严重程度和临床结局均无关联。结论　机械通气危重患儿的静息能量消耗IC法实测值随机械通气时间变化并不显著,预测公式估算的静息能量消耗值与IC法实际测量值之间一致性较差。建议将IC应用于重症监护病房,指导危重患儿个体化营养支持治疗,以改善患儿临床结局。     

危重病儿童机械通气后静息能量消耗变化

目的了解危重病儿童机械通气后能量代谢状态,探讨机械通气时间及疾病类别对危重病儿童机械通气后能量代谢的影响。方法以50例儿童重症监护病房机械通气后的危重病儿童为研究对象,开始机械通气治疗第1、3、5、7天,采用美国麦加菲营养能量代谢测定系统测定静息能量消耗值,分别记作实测值1、实测值3、实测值5、实测值7;运用Schofield-H邢汀公式计算入选患儿的预测静息能量消耗值。结果50例患儿实测值．和Schofield—HTWT公式预测值分别为（96．80±42．63）和（110．67±38．35）kJ／d。其中35例（70％）患儿的实测值低于90％Schofield—HTwT预测值。22例患儿的实测值,、实测值,、实测值,、实测值,分别为（100．53±50．24）、（113．80±49．19）、（117．99±50．57）、（115．05±50．18）kJ／d,4个不同时间点比较差异无统计学意义（F=1．267,P=0．292）。先天性心脏病儿童和非先天性心脏病儿童实测值,分别为（75．66±31．23）和（113．40±28．40）kJ／d,两不同疾病类别比较差异具有统计学意义（F=10．423,P=0．002）。结论危重病儿童机械通气后大多数呈现低代谢状态;危重病儿童机械通气后的静息能量消耗在开始通气1周内并不随机械通气时间而改变;机械通气后的危重病儿童中,先天性心脏病儿童的静息能量消耗比非先天性心脏病儿童的静息能量消耗明显降低。     

连续性肾脏替代疗法治疗高龄急性肾损伤患者的回顾性研究

目的分析影响床旁连续性肾脏替代疗法（CRRT）治疗高龄急性肾损伤（AKI）患者预后的相关因素,探讨改善疗效的措施。方法对解放军总医院南楼肾科2000年1月～2010年12月因AKI行床旁CRRT的危重高龄患者41例进行回顾性研究。按患者存活与否分为存活组16例和死亡组25例,比较两组累及器官数目及生理学和慢性健康评估Ⅱ（APACHEⅡ）评分等可能影响预后的因素。结果存活16例,死亡25例,总病死率60.98%。所有患者APACHEⅡ评分（27.8±5.6）分,危险系数0.80±0.10;其中存活组（26.56±3.46）分,死亡组（32.36±2.83）分,两组比较,差异有统计学意义（P〈0.05）。治疗剂量〈25ml/（kg·h）与25～50ml/（kg·h）比较（P=0.222）,以及25～50ml/（kg·h）与〉50ml/（kg·h）比较（P=0.122）,均差异无统计学意义。CRRT患者预后与累及器官数目（r=0.690,P〈0.001）和APACHEⅡ评分（r=0.664,P〈0.001）相关。logistic回归分析显示,累及器官数目（P=0.024）、APACHEⅡ评分（P=0.048）、机械通气（P=0.030）、低白蛋白血症（P=0.040）是影响床旁血液滤过患者预后的主要危险因素。结论 CRRT高龄患者的转归与累及器官数目、APACHEⅡ评分、机械通气和低白蛋白血症等因素相关。APACHEⅡ评分是开始CRRT治疗时机的重要参考指标,并可以预测患者的死亡风险。     

早期乳酸清除率与急性生理学和慢性健康状况Ⅱ评分在急性一氧化碳中毒性脑病中的应用价值

目的探讨早期乳酸清除率与急性生理学和慢性健康状况（APACHE）Ⅱ评分在急性一氧化碳中毒性脑病中的应用价值。方法根据有无发生中毒性脑病,将急性重度一氧化碳中毒患者分为对照组（60例）和病例组（86例）,分别在治疗前及治疗6,24,72h后不吸氧条件下抽取1ml动脉血,检测动脉血乳酸,计算乳酸清除率。比较两组患者的初始血乳酸水平;治疗6,24,72h后乳酸清除率和APACHEⅡ评分;并发症和病死率。结果病例组与对照组比较,初始血乳酸水平高[（3．30±0．55）mmol/L比（2．64±0．24）mmol/L],治疗6,24h后乳酸清除率明显低[（8．22±1．20）％比（12．83±5．31）％、（12．00±2．40）％比（15．17±2．99）％],治疗6,24,72h后APACHEⅡ评分高[（16．78±2．82）分比（12．33±2．16）分、（14．11±1．54）分比（10．17±0．98）分、（10．56±1．51）分比（7．83±1．17）分],并发症发生率、病死率高,差异均有统计学意义（P〈0．05）;而治疗72h后乳酸清除率比较差异无统计学意义（P〉0．05）。急性一氧化碳中毒性脑病患者,治疗6h后乳酸清除率与APACHEⅡ评分呈负相关（r=-0．616,P=0．015）,与病死率呈负相关（r=-0．606,P=0．017）。结论早期乳酸清除率与APACHEⅡ评分对于急性一氧化碳中毒性脑病患者有助于严重程度的评估、指导治疗和判断预后。     

急性生理学与慢性健康状况Ⅱ评分在亚低温脑复苏患者中的运用及回归模型建立

目的应用急性生理学与慢性健康状况Ⅱ（APACHEⅡ）评分评价亚低温脑复苏患者的病情危重程度并判断其预后,以评估其应用的有效性。方法连续收集入急诊重症监护室（ECIU）或重症监护室（mu）的亚低温脑复苏患者共34例,分别计算各自APACHEⅡ评分,并进行验证,建立回归模型。结果纳入的34例患者APACHEⅡ评分20—47（33．86±5．12）分。9例72h内存活者为（27．83±4．89）分,25例72h内死亡者为（35．56±7．12）分,两者比较差异有统计学意义（P〈0．01）。非条件Logistic回归分析显示,APACHEⅡ评分是亚低温脑复苏患者死亡的危险因素（P〈0．01）。结论APACHEⅡ评分可应用于亚低温脑复苏患者的病情危重程度及预后的评估,指导临床决策。     

APACHEⅡ评分对急诊室无创通气治疗患者的预后评估价值

目的应用急性生理与慢性健康状况评分（APACHE）Ⅱ评分系统对急诊内使用无创通气治疗的患者进行病情顸后分析。方法回顾性分析2010年1月一2012年7月急诊室使用无创通气的急危重症患者的APACHEⅡ评分结果,根据患者的死亡和接受气管插管作为预后不良,成功脱机为预后良好,比较预后良好和预后不良患者临床特征、病因和APACHEⅡ分值间的差异,评价APACHEⅡ和预后的相关性。结果62例入选病例中男34例,女28例,根据BIPAP治疗后病情转归情况分为：预后良好组32例,预后不良组30例。预后不良组APACHEⅡ评分分值明显高于预后良好组（P〈0．01）,单因素回归分析发现APACHEⅡ分值与患者预后不良的发生率呈正相关（OR：1．112,P=0．029）,APACHEⅡ分值可预测患者预后不良,曲线下面积为0．658（P〈0．02）,Cutoff值为〉17,其诊断灵敏度为66．67（47．2～82．7）,特异度为59．38（40．6～76．3）。阳性预测值60．6（42．1—77．1）,阴性预测值65．5（45．7～82．1）。结论APACHEⅡ评分对急诊室内使用无创通气的不同病因的患者具有一定的预后预测作用。     

正常人及慢性阻塞性肺病患者的静息能量消耗

为进一步评价Harris-Benedict公式估算能量消耗的临床应用价值，采用开放式间接代谢测定仪测定65例健康成人及35例稳定期慢阻肺（COPD）患者的静息能量消耗（REE）。结果表明，65例健康成人REE为1492．15±250．83Kcal／d，比Harris-Benedict公式估算的基础能量消耗（BEE）高4．3％（P＜0．05）。35例稳定期COPD患者REE为1521．29±208．33Kcal／d，比BEE高20．39（P＜0．001），COPD患者公斤体重REE明显高于对照组（P＜0．001），且与体重占理想体重百分比及第一秒时间肺活量占预计值百分比呈显著负相关（γ值分别为－0．6，－0．57，P＜0．001）。提示CDPD患者静息能量消耗增高，且随体重及气道阻力的变化差异增大，应用HBE公式时需对其矫正。     

先天性心脏病患儿术后静息能量消耗

目的　应用间接测热法（IC）测定先天性心脏病术后机械通气患儿的静息能量消耗（REE）,探究先天性心脏病患儿术后静息能量代谢规律及可能影响因素。方法　纳入2015年2至6月入住上海儿童医学中心心胸外科重症监护室的先天性心脏病术后患儿共150例,于术后4 h应用代谢车测定REE。收集患儿一般人口学和人体测量学资料、临床资料,分析临床因素与REE的相关性。比较患儿术后营养摄入与REE的关系。结果　入组患儿150例,男104例、女46例,中位年龄14（8.3~36.0）个月。IC测得非蛋白呼吸商为0.79±0.20,REE实测值（MREE)（264.76±61.74）kJ/(kg·d),与Schofield公式估算值（278.51±93.42）kJ/(kg·d)比较,差异无统计学意义（P=0.096）,但相关性较低（R2=0.119）;多因素逐步回归分析显示先天性心脏病风险校正评分（RACHS-1）与MREE呈显著正相关（P=0.012）、年龄与MREE呈显著负相关（P=0.010）。术后97.33%（146/150）患儿第1天摄入热量低于MREE。结论　先天性心脏病术后并未出现明显高代谢状态,但影响底物代谢。RACHS-1评分、年龄是影响患儿术后REE的因素。先天性心脏病患儿术后第1天摄入热量普遍低于REE。     

血液灌流联合大黄治疗急性重度阿维菌素中毒临床观察

目的观察血液灌流联合大黄治疗急性重度阿维菌素中毒临床效果。方法将患者按随机数字表法分为两组,对照组采用一般常规对症支持治疗。治疗组在一般常规对症支持治疗的基础上,采用血液灌流联合大黄鼻饲,观察两组患者的意识恢复时间、血压平稳时间、机械通气时问、72h后APACHEⅡ评分。结果治疗组在意识恢复时间、血压平稳时间、机械通气时间、APACHEⅡ评分方面与对照组比较差异有统计学意义（P〈0．05）。结论血液灌流联合大黄可以有效治疗急性重度阿维菌素中毒。     

An evaluation of resting energy expenditure in hospitalized, severely underweight patients.

A prospective trial was conducted with 14 hospitalized patients who were severely underweight with a mean weight of 40.9+/-5.1 kg and 70.7+/-7.8% of ideal body weight, to compare estimates of resting energy expenditure (REE) with measured values. The 9 women and 3 men, whose mean age was 66.5+/-13.9 y, underwent nutritional assessment and measurement of their REE by indirect calorimetry using the Sensormedics Deltatrac MBM100 indirect calorimeter. Their REE was also estimated by the Harris-Benedict formula (mean 1032+/-66 kcal/d) as well as a previously established empirical formula where REE = 25 x body weight in kg (mean 1023+/-129 kcal/d). Results by both estimates were significantly lower than the measured resting energy expenditure (MREE) in this group of patients (P<0.0001). The percentage difference between MREE and estimated REE by the Harris-Benedict formula was 18.4+/-9.4% and 20.9+/-7.5% by the empirical formula. The MREE exceeded the estimated REE in each individual. The correlation between MREE and body weight (r2 = 0.558, r = 0.005) was better than that between MREE and estimated REE by Harris-Benedict formula (r2 = 0.275, P = 0.08) suggesting that weight was the principal determinant rather than the other components (height, age, sex) of the Harris-Benedict formula. Our data shows that commonly employed formulae routinely underestimate the energy needs of severely underweight patients below 50 kg in body weight. The Harris-Benedict equation had limited predictive value for the individual, explaining approximately 25% of the variance in energy expenditure. Given the particular importance of matching energy intake to needs in this group of patients with limited reserves, many of whom are critically ill, we suggest an empirical equation using 30-32 kcal/kg be used to estimate the energy requirements of severely underweight patients when direct measurements are unavailable or clinically less imperative.     

Measured versus estimated energy expenditure in mechanically ventilated critically ill patients

Accurate determination of energy expenditure is essential in patients receiving nutritional support to meet metabolic needs. The purpose of this study was to assess and compare the energy expenditure as measured by indirect calorimetry (MEE) and estimated by 5 equations in the mechanically ventilated critically ill patients. Forty-six patients were divided into either enteral nutrition (EN) (n=l2), total parenteral nutrition (TPN) (n=16) or combined (EN plus TPN) (n=l8) groups. Patients' energy expenditure was measured by indirect calorimetry on two occasions. Anthropometric and biochemical measurements, energy expenditure and medical status (APACHE II score) were also assessed in the intensive care unit (ICU) of Taichung Veteran General hospital. No significant difference was found in the MEE among the 3 groups. The type of nutritional support did not affect MEE. Energy expenditure calculated by using Harris- Benedict, Kleiber and Liu equations times the estimated stress factor did not significantly different than the values of MEE in all groups. There were significant correlations (P<0.01) between MEE and patients' sex (r=-0.499), age (r=-0.402), height (r=0.533), knee height (r=0.431), current body weight (r=0.379), usual body weight (r=0.407), ideal body weight (r=0.466) and urinary urea nitrogen (r=0.383) in the pooled group. Results demonstrated that energy expenditure could be estimated in most critically ill patients by using Harris-Benedict, Kleiber and Liu equations if the estimated stress factor is in the reasonable value.     

危重病患者动脉血乳酸水平与急性生理学及慢性健康状况评分和预后相关性研究

目的 探讨危重病患者动脉血乳酸水平与急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)之间的关系.方法 选择危重病患者71例,根据预后将患者分为死亡组16例和存活组55例,分析两组患者入院24 h内动脉血乳酸水平与APACHE Ⅱ及预后之间的关系.结果 随着APACHEⅡ的增加,动脉血乳酸水平和病死率均显著升高,APACHEⅡ>30分时,血乳酸水平已达(8.20±3.52)mmol/L,病死率则为64.7%(11/17),各分值之间比较差异均有统计学意义(P＜0.05).直线相关分析显示:动脉血乳酸水平与APACHEⅡ呈显著正相关(r=0.563,P<005).死亡组的APACHEⅡ和动脉血乳酸水平分别为(29.7±6.9)分和(7.6±4.1)mmol/L,均显著高于存活组的(18.3±7.0)分和(3.0±1.7)mmol/L,差异有统计学意义(P＜0.05).结论 危重病患者动脉血乳酸水平与 APACHEⅡ呈正相关关系,其水平对于判断危重病患者病情的严重程度和预后有重要临床意义.

Abstract：

Objective To investigate the correlation between arterial blood lactate levels and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) in critically ill patients.Methods Seventy-one patients with critical illness who treated in intensive care unit were included as research subjects and divided into death group with 16 cases and survival group with 55 cases according to the prognosis.The correlation between arterial blood lactate levels and APACHE Ⅱ was analyzed.Results With the increase of APACHE Ⅱ ,arterial blood lactate levels and mortality all increased significantly.The blood lactate levels reached (8.20±3.52) mmol/L and mortality was 64.7%(11/17) when APACHE Ⅱ >30 scores,and there were significant differences between different segment of APACHE Ⅱ (P <0.05).Linear correlation analysis showed:arterial blood lactate levels were positively correlated to APACHE Ⅱ significantly (r = 0.563,P <0.05).The APACHE Ⅱ and arterial blood lactate levels in the death group were (29.7 ± 6.9) scores and (7.6 ±4.1) mmol/L respectively,which were significantly higher than those in the survival group [(18.3 ± 7.0) scores and(3.0 ± 1.7) mmol/L].The differences between two groups were statistically significant (P＜0.05).Conclusion The arterial blood lactate levels of critically ill patients are positively related to APACHE Ⅱ ,and its level has an important clinical significance in judging the severity and the prognosis of the illness.     

Predictive versus measured energy expenditure using limits-of-agreement analysis in hospitalized, obese patients.

BACKGROUND: Accuracy of predictive formulae is crucial for therapeutic planning because indirect calorimetry measurement is not always possible or cost effective. Energy requirements are more difficult to predict in the acutely ill obese patient compared with lean patients because of an increased resting energy expenditure per lean body mass and a variable stress response to illness. METHODS: A retrospective review of 726 patients identified 57 patients (32 spontaneous breathing, S; 25 ventilator dependent, V) with body mass indexes of 30-50 kg/m2. Limits-of-agreement analysis determined bias (the mean difference between measured and predicted values) and precision (the standard deviation of the bias) to evaluate the accuracy of predictive formulae compared with measured resting energy expenditure (MREE) by a Deltatrac Metabolic Monitor. Predictive accuracy was determined within+/-10% MREE. The predictive formulae examined were: variations of the Harris-Benedict equations using ideal, adjusted weights of 25% and 50% and actual weights with stress factors ranging from 1.0 to 1.5; the Ireton-Jones equation for obesity; the Ireton-Jones equations for hospitalized patients (S and V); and the ratio of 21 kcalories per kilogram actual weight. RESULTS: The mean MREE was 21 kcal/kg actual weight. The adjusted Harris-Benedict average weight equation was optimal for predicting MREE for the combined S and V sets (bias = 182+/-123; 67%+/-10% MREE), as well as the S subset (bias = 159+/-112; 69%+/-10% MREE). CONCLUSIONS: The Harris-Benedict equations using the average of actual and ideal weight and a stress factor of 1.3 most accurately predicted MREE in acutely ill, obese patients with BMIs of 30-50 kg/m2. Predictive formulae were least accurate for obese, ventilator-dependent patients.     

The effects of standard and branched chain amino acid enriched solutions on thermogenesis and energy expenditure in unconscious intensive care patients

BACKGROUND & AIMS: This study aims to compare the effects of standard and branched chain amino acid enriched solutions on thermogenesis and energy expenditure in unconscious and mechanically ventilated intensive care patients. DESIGNS: The study was carried out at multidisciplinary intensive care unit. Twenty unconscious and mechanically ventilated patients (18-65 years of age) were included in the study. Patients were hemodynamically stable and all received continuous enteral nutrition. Energy expenditure was calculated using the Harris-Benedict Equation for all of the patients. Patients were randomly assigned to receive a 4h infusion of 0.4 g/kg protein as amino acid solution. Group I (n = 10) received standard amino acid solution and group II (n = 10) received branched chain amino acid enriched solution. Energy expenditure, oxygen consumption and carbon dioxide production were measured by indirect calorimetric method every 30 min during the 4h infusion period and 3h thereafter. Rectal temperature was recorded concomitantly with the metabolic measurements throughout the study. RESULTS: There was a statistically significant increase in body temperature during the infusion of amino acid solution between 30 and 210 min in group I and between 30 and 120 min in group II (P <0.05). We observed a significant increase in energy expenditure at 30, 150, 180 and 210 min in group I and at 30-240 min in group II (P <0.05). There were no differences between the two groups in terms of thermogenesis or energy expenditure values during the study (P >0.05). CONCLUSION: Thermogenesis and energy expenditure values were increased during the parenteral infusion of both standard amino acid and branched chain amino acid enriched solutions in unconscious intensive care patients without any significance in between.     

脓毒症患者外周血CD4+CD25+调节性T细胞水平与APACHEⅡ评分相关性的临床研究

目的 探讨脓毒症患者外周血CD4+CD25+调节性T细胞水平及其与疾病严重程度的相关性.方法 选取脓毒症患者36例,依据诊断标准分为脓毒症组10例、严重脓毒症组15例和脓毒性休克组11例,以健康志愿者5例作为对照组.于入ICU时抽取外周血,分离淋巴细胞,以藻红蛋白(PE)标记的抗人CD4和异硫氰酸荧光素(FTTC)标记的抗人CD25单克隆抗体标记细胞,流式细胞仪检测CD4+CD25+调节性T细胞含量.并结合各组不同时间点的急性生理学及慢性健康状况(APACHE)Ⅱ评分,分析CD4+CD25+调节性T细胞与APACHEⅡ评分的相关性.结果 脓毒症组、严重脓毒症组和脓毒性休克组外周血CD4+CD25+调节性T细胞含量[分别为(10.31±2.32)%、(14.27±3.33)%、(15.32±3.98)%]均较对照组[(5.48±0.98)%]显著增高(P＜0.05或＜0.01).各组CD4+CD25+调节性T细胞水平与APACHEⅡ评分呈明显正相关,相关系数分别为0.829(P=0.032)、0.868(P=0.021)、0.913(P=0.009),总相关系数为0.903(P=0.013).结论 脓毒症患者外周血CD4+CD25+调节性T细胞明显升高,且与疾病严重程度相关.     

Comparison between measured and predicted resting energy expenditure in mechanically ventilated patients with COPD

The aim of this study was to compare resting energy expenditure (REE) obtained by indirect calorimetry (IC) and Harris-Benedict (H-B) equations, and to examine whether hypocaloric nutrition support could improve protein nutritional status in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). Thirtythree COPD patients (20 males, 13 females) were recruited and REE was measured by IC. Measured REE (REEm) was compared to predictive REE by H-B equations (REEH-B) and its corrected values. Correlation between REEm and APACHE II score was also analyzed. Patients were randomly divided into hypocaloric energy group (50%-90% of REEm, En-low) and general energy group (90%-130% of REEm, En-gen) for nutrition support. The differences of albumin, prealbumin, transferrin, hemoglobin, and lymphocyte count before and after 7 days nutrition support were observed. Results show that REEH-B and REEH-B×1.2 were significantly lower than REEm (p<0.01). REEm positively correlated with APACHE II score (p<0.05 or p<0.01). After nutrition support, hemoglobin decreased significantly in En-gen group (p<0.05); lymphocyte count in both groups, and transferrin and prealbumin in the En-low group increased significantly (p<0.05 or p<0.01). Our data suggest that 1) these patients' REE were increased; 2) since IC is the best method to determine REE, in the absence of IC, H-B equations (with standard body weight) can be used to calculate REE, but the value should be adjusted by correction coefficients derived from APACHE II; 3) low energy nutrition support during mechanical ventilation in COPD patients might have better effects on improving protein nutritional status than high energy support.     

Energy expenditure in chronic alcoholics with and without liver disease

Chronic alcoholism activates metabolic pathways, resulting in wasteful expenditure of energy (Pirola and Lieber, J Nutr 1975;105:1544-8). To study this hypothesis, we measured oxygen consumption (VO2), carbon dioxide production (VCO2), and resting energy expenditure (MREE) utilizing indirect calorimetry in 8 chronic alcoholics with (group I) and 11 chronic alcoholics without (group II) clinical or biochemical evidence of alcoholic liver disease. Seven healthy volunteers served as controls. A statistically increased MREE was observed in group II subjects (p less than 0.05, MREE 999.7 +/- 111.4 kcal X day X m2) as compared to normals (MREE 842.3 +/- 42.1 kcal X day X m2) and group I subjects (MREE 813.4 +/- 101.4 kcal X day X m2). VO2 and VCO2 were also significantly higher (p less than 0.05) in group II than in group I and normals. The predicted resting energy expenditure as calculated by the Harris-Benedict equation was similar in both groups and normals. Theories to explain the increased MREE in group II subjects are presented.