Mortality associated with new risk classification of developing refeeding syndrome in critically ill patients: A cohort study

Yoshida, Minoru; Izawa, Junichi; Wakatake, Haruaki; Saito, Hiroki; Kawabata, Chizu; Matsushima, Shigeru; Suzuki, Aya; Nagatomi, Akiyoshi; Yoshida, Toru; Masui, Yoshihiro; Fujitani, Shigeki

doi:10.1016/j.clnu.2020.07.034

Cited by 12 publications

(4 citation statements)

References 40 publications

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“…The patient populations were divided as four groups: no risk, low risk, high risk and very high risk groups. There were a few studies explaining the relevance between this risk evaluation and outcomes of patients based on this classification as mentioned above, but there was no notable result reporting a relevance between risk assessment and actual incidence of RS [20]. In this study, "ASPEN consensus recommendations for refeeding syndrome", which specified criteria to identify the patients at risk for RS in advance was used as a risk evaluation.…”

Section: Discussionmentioning

confidence: 99%

Refeeding Syndrome in Critically Ill Patients

Hong

2022

Ann Clin Nutr Metab

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The aim of this study is to demonstrate clinical characteristics of refeeding syndrome (RS) and clinical utility of several guidelines including American Society for Parenteral and Enteral Nutrition consensus recommendations for RS and National Institute for Clinical Excellence guidelines. Materials and Methods: Eighty-six patients screened for RS based on two guidelines were enrolled in this study. We evaluated the severity of RS after the initiation of 'dextrose infusion' and 'balanced nutrition support' with calculation of 5-day electrolyte changes. The primary outcome was 6-month mortality and secondary outcomes were duration of intensive care unit stay in days, duration of mechanical ventilation in days, and ventilator-free days at the 28th day. Results: We observed statistically different distributions in terms of prevalence of RS on the basis of two different start times of caloric support (P=0.021). There was no statistically significant relationship between the risk of RS and severity of RS based on both guidelines. Also, the relevance between severity of RS and outcomes was not significant in our study. In multivariable logistic regression analysis of factors associated with outcomes, the significant factor for primary outcome was the 'patients with significant risk' (odds ratio, 9.65; 95% confidence interval, 1.83~50.90; P=0.007). Conclusion:We demonstrated that even initial administration of dextrose solution and propofol could cause severe RS in critically ill patients. In addition, significant risk of RS was a predictive factor for 6-month mortality. Thus, it is essential to monitor the occurrence of RS even during initial resuscitation in patients with unstable metabolism.

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Section: Discussionmentioning

confidence: 99%

Refeeding Syndrome in Critically Ill Patients

Hong

2022

Ann Clin Nutr Metab

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“…24 Yoshida et al used the NICE guidelines to operationalize RFS risk classification and found an association between RFS and death. 25 Future research can test other guidelines to classify RFS. 26 On the other hand, a prospective cohort study in the United Kingdom mirrored the NICE criteria, focusing on unintentional weight loss and energy deficit, but found no association between RFS and death among ICU patients.…”

Section: Discussionmentioning

confidence: 99%

“…Another definition for RFS was based on the criteria provided by Britain's National Institute for Health and Care Excellence (NICE), which operationalizes RFS based on at least one of the following conditions: BMI <16 kg/m 2 , a recent unintentional weight loss >15%, minimal nutrition intake for >10 days, and/or low plasma concentrations of potassium, phosphate or magnesium before feeding; and those with at least two of the following conditions: BMI <18.5 kg/m 2 , a recent weight loss >10%, very little nutrition intake for >5 days, and/or a history of alcohol abuse or drug use, including insulin, chemotherapy or diuretics 24 . Yoshida et al used the NICE guidelines to operationalize RFS risk classification and found an association between RFS and death 25 . Future research can test other guidelines to classify RFS 26 .…”

Section: Discussionmentioning

confidence: 99%

Assessment of refeeding syndrome definitions and 30‐day mortality in critically ill adults: A comparison study

Naik,

Li,

Seres

et al. 2023

J Parenter Enteral Nutr

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BackgroundPatients in the intensive care unit (ICU) are at high risk for refeeding syndrome (RFS), yet there is uncertainty regarding how RFS should be operationalized in the ICU. We evaluated different definitions for RFS and tested how they associated with patient‐centered outcomes in the ICU.MethodsThis was a retrospective comparison study. Patients age ≥18 years were eligible if they were newly initiated on enteral feeding while hospitalized in the ICU. Eight definitions for RFS were operationalized, including that from the American Society for Parenteral and Enteral Nutrition (ASPEN), all based on electrolyte levels from immediately before until up to 5 days after the initiation of enteral nutrition. Patients were followed for death or for ICU‐free days, a measure of healthcare utilization.ResultsIn all, 2123 patients were identified, including 406 (19.1%) who died within 30 days of ICU admission and 1717 (80.9%) who did not. Prevalence of RFS varied from 1.5% to 88% (ASPEN definition) depending on the RFS definition used. The excess risk for death associated with RFS varied from 33% to 92% across definitions. The development of RFS based on the ASPEN definition was associated with a greater decrease in ICU‐free days compared with other definitions, but the relationship was not statistically significant.ConclusionEight definitions for RFS were evaluated, none of which showed strong associations with death or ICU‐free days. It may be challenging to achieve a standardized definition for RFS that is based on electrolyte values and predicts mortality or ICU‐free days.

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“…RFS may lead to coma, lethal cardiac arrhythmias, heart arrest, acute respiratory failure, and even death [ 4 , 5 ]. Previous studies have connected a longer Intensive Care Unit (ICU)stay, increased mortality, and disability with the occurrence of RFS [ 6 , 7 , 8 ]. Although RFS is lethal, it can be prevented by identifying patients at high risk and restraining nutrition during refeeding to this group [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

The Performances of SNAQ, GLIM, mNICE, and ASPEN for Identification of Neurocritically Ill Patients at High Risk of Developing Refeeding Syndrome

et al. 2022

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We previously found that neurocritically ill patients are prone to refeeding syndrome (RFS), a potentially life-threatening complication. However, there is no unified or validated consensus on the screening tool for RFS so far. We aimed to validate and compare the performance of four screening tools for RFS in neurocritically ill patients. We conducted a single-center, observational, retrospective cohort study among neurocritically ill adult patients who were admitted to the neurocritical care unit (NCU), and who received enteral nutrition for 72 h or longer. They were scored on the Short Nutritional Assessment Questionnaire (SNAQ), the Global Leadership Initiative on Malnutrition (GLIM), the modified criteria of the Britain’s National Institute for Health and Care Excellence (mNICE), and ASPEN Consensus Recommendations for Refeeding Syndrome (ASPEN) scales to predict RFS risk via admission data. The performance of each scale in predicting RFS was evaluated. Logistic regression analysis was used to identify the independent risk factors for RFS, and they were added to the above scales to strengthen the identification of RFS. Of the 478 patients included, 84 (17.57%) developed RFS. The sensitivity of the SNAQ and GLIM was only 20.2% (12.6–30.7%), although they had excellent specificities of 84.8% (80.8–88.1%) and 86.0% (82.1–89.2%), respectively; mNICE predicted RFS with a sensitivity of 48.8% (37.8–59.9%) and a specificity of 65.0% (60.0–69.9%); ASPEN had the highest Youden index, with a sensitivity and specificity of 53.6% (42.4–64.4%) and 64.7% (59.8–69.4%), respectively. The Area Under the receiver operating characteristic Curves (AUC) of SNAQ, GLIM, mNICE, and ASPEN to predict RFS were 0.516 (0.470–0.561), 0.533 (0.487–0.579), 0.568 (0.522–0.613), and 0.597 (0.551–0.641), respectively. We identified age, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Glasgow Coma Scale (GCS) score as independent risk factors of RFS, and the combination of GCS and age can improve the AUC of ASPEN to 0.664 (0.620–0.706) for predicting RFS. SNAQ, GLIM, mNICE, and ASPEN do not perform well in identifying neurocritically ill patients at high risk of RFS, although ASPEN appears to have relatively a good validity among them. Combining GCS and age with ASPEN slightly improves RFS recognition, but it still leaves a lot of room for improvement.

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Mortality associated with new risk classification of developing refeeding syndrome in critically ill patients: A cohort study

Cited by 12 publications

References 40 publications

Refeeding Syndrome in Critically Ill Patients

Refeeding Syndrome in Critically Ill Patients

Assessment of refeeding syndrome definitions and 30‐day mortality in critically ill adults: A comparison study

The Performances of SNAQ, GLIM, mNICE, and ASPEN for Identification of Neurocritically Ill Patients at High Risk of Developing Refeeding Syndrome

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