Time course of energy expenditure in persistent critical illness: a prospective multicentre study
Authors' conclusion
Mean energy expenditure follows a biphasic pattern during prolonged ICU stay, with the inflection point coinciding with the empirical onset of persistent critical illness.
Study context
- Population
- Adults with persistent critical illness (ICU LOS ≥ 10 days) and ≥ 1 indirect calorimetry, 5 European and 2 Australian ICUs, 2022–20241,194 measurements
- Participants
- 433 adults
- Outcome
- Change in energy expenditure over time
Methodological detailsmulticentre, mixed-effects models with restricted cubic splines, latent class analysis
- Multicentre
- Mixed-effects models with restricted cubic splines
- Latent class analysis
Main finding
As reported in the abstract
Energy expenditure over time
- Initial increase in energy expenditure, peaking around day 10, then decline
- p < 0.001
- Still significant after adjustment (sex, age, CRP, FiO2, fever, BMI, RRT, protein; patient and site random effects)
- p = 0.001
- Conditional R²
- 0.76
Observational data: associations, not effects.
Further findings
Respiratory quotient vs time
- Association non-significant
- P = 0.067
Urea: creatinine ratio · first 10 days
- Increased over the first 10 days
- P < 0.001
Energy expenditure trajectories (latent class analysis)
- Three trajectories: hypo-, normo- and hypermetabolism; entropy
- 0.63
Original publication
Time course of energy expenditure in persistent critical illness: a prospective multicentre study. Crit Care. Published 27 May 2026. doi:10.
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