Ketone changes at end of life

  • Research type

    Research Study

  • Full title

    Changes in fat content towards the end of life – a feasibility study

  • IRAS ID

    259715

  • Contact name

    Seamus Coyle

  • Contact email

    s.coyle@liverpool.ac.uk

  • Sponsor organisation

    St Helens and Knowsley Hospitals Trust

  • Duration of Study in the UK

    0 years, 5 months, 30 days

  • Research summary

    This work could identify mechanisms involved in the dying process. This project is interested in looking at changes in the body fat stores of people towards the end of life. There is some evidence suggesting that fat metabolism changes towards the end of life. This includes mouse and rat models of old age where studies have shown that there is rapid weight loss (fat loss) in the last 5-6 weeks of life. Fat loss can be monitored by measuring ketone body levels, which are easily measured using a glucometer. Ketone levels change as a normal response to starvation, should increase when there is increased lipolysis, as happens in terminal cancer cachexia and do not increase when there is sepsis or trauma despite limited nutrition. No prospective studies have investigated changes in fat metabolism towards the end of life in palliative patients.

    We need to know:
    - Is there progressive or rapid fat loss in the last days of life? i.e. is there an increase in serum ketone levels?
    - What happens to the fat content in people with cachexia in the last weeks of life? i.e. are there high ketone levels normally that decrease in the last days as happens in starvation?

    In this feasibility study we will recruit palliative inpatients and prospectively measure serial ketone concentrations from capillary blood. We will also collect urine samples for further laboratory analysis. The study will recruit for 6 months and aim to recruit 30 participants in the last 2 weeks of life.

    Understanding of the biology of dying will improve identifying people in the last days and weeks of life. This will;
    - improve the quality of a person’s death by reducing uncertainty and facilitating preferred place of care.
    - reduce healthcare spending on futile diagnostic and therapeutic interventions.

  • REC name

    Wales REC 5

  • REC reference

    19/WA/0034

  • Date of REC Opinion

    22 Feb 2019

  • REC opinion

    Favourable Opinion