Incidence and outcome of refeeding syndrome in neurocritically ill patients

Xiong, Ruiqi; Huang, Hua; Wu, Yongming; Wang, Shengnan; Wang, Dongmei; Zhong, Jian; Lin, Zhenzhou; Zang, Nailiang; Pan, Suyue; Huang, Kaibin

doi:10.1016/j.clnu.2020.06.038

Cited by 19 publications

(16 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the present study, we found that low GCS, high APACHE II, and SOFA scores were associated with increased odds of RFS, indicating that RFS was also correlated with disease severity, which is consistent with our previous study [ 19 ]. The reason for this may be that the metabolic stress of critical illness leads to pathophysiological disturbance, a condition where metabolic disorders of electrolytes and vitamins are more likely to occur [ 1 , 3 ].…”

Section: Discussionsupporting

confidence: 93%

“…Therefore, we used the diagnostic criteria for RFS, consistent with those in two recent high-quality studies, namely, a drop of more than 0.16 mmol/L (0.5 mg/dL) in serum phosphate from any previous baseline, and under the threshold of 0.65 mmol/L (2.0 mg/dL) [ 1 , 22 ]. Consistent with our previous study [ 19 ], we found that the incidence of RFS in neurocritically ill patients was about 17%. It is worth mentioning that by using this definition of RFS, we excluded patients with baseline serum phosphate < 0.65 mmol/L (2.0 mg/dL), which might have some influence on the incidence of RFS and the performance of the four prediction tools in this study.…”

Section: Discussionsupporting

confidence: 93%

“…This study further confirmed that RFS was not uncommon in neurocritically ill patients, with an incidence of 17.6%, which is consistent with our previous study [ 19 ]. Four screening tools for RFS, namely SNAQ, GLIM, mNICE, and ASPEN, did not perform well in identifying neurocritically ill patients at risk of RFS.…”

Section: Discussionsupporting

confidence: 93%

“…The general criteria for NCU admission were Glasgow Coma Scale (GCS) < 12, and/or admission for Acute Physiology and Chronic Health Evaluation (APACHE II) score > 15. Otherwise, patients were still admitted to NCU if they suffered from large hemisphere infarction, massive cerebellar infarction, severely intracerebral hemorrhage, or other life-threatening neurological diseases, as shown in our previous studies [ 19 ]. We only evaluated patients at the first admission if they were re-admitted during the same admission period.…”

Section: Methodsmentioning

confidence: 99%

“…Enteral nutrition is the first choice for neurocritically ill patients, but it is more likely to develop RFS, due to the incretin effect of absorption of glucose [ 13 ]. In our previous study, we found a 17% incidence of RFS in neurocritically ill patients, and found that RFS was an independent risk factor for 6-month mortality [ 19 ]. Therefore, it is of great clinical significance to find an appropriate RFS screening tool for neurocritically ill patients.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

et al. 2022

View full text Add to dashboard Cite

show abstract

Risk factors for the development of refeeding syndrome in adults: A systematic review

Zheng,

Chen,

Chen

et al. 2024

Nut in Clin Prac

View full text Add to dashboard Cite

Identifying patients with a particularly high risk of refeeding syndrome (RFS) is essential for taking preventive measures. To guide the development of clinical decision‐making and risk prediction models or other screening tools for RFS, increased knowledge of risk factors is needed. Therefore, we conducted a systematic review to identify risk factors for the development of RFS. PubMed, EMBASE, Cochrane Library, and Web of Science were searched from January 1990 until March 2023. Studies investigating demographic, clinical, drug use, laboratory, and/or nutrition factors for RFS were considered. The Newcastle‐Ottawa Scale was used to appraise the methodological quality of included studies. Of 1589 identified records, 30 studies were included. Thirty‐three factors associated with increased risk of RFS after multivariable adjustments were identified. The following factors were reported by two or more studies, with 0–1 study reporting null findings: a previous history of alcohol misuse, cancer, comorbid hypertension, high Acute Physiology and Chronic Health Evaluation II score, high Sequential Organ Failure Assessment score, low Glasgow coma scale score, the use of diuretics before refeeding, low baseline serum prealbumin level, high baseline level of creatinine, and enteral nutrition. The majority of the studies (20, 66.7%) were of high methodological quality. In conclusion, this systematic review informs on several risk factors for RFS in patients. To improve risk stratification and guide development of risk prediction models or other screening tools, further confirmation is needed because there were a small number of studies and a low number of high‐quality studies on each factor.

show abstract

Nutrition in the Neurocritically Ill Patient

Overholt,

Badjatia

2024

Textbook of Neurointensive Care: Volume 2

View full text Add to dashboard Cite

Incidence and outcome of refeeding syndrome in neurocritically ill patients

Cited by 19 publications

References 30 publications

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

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

Risk factors for the development of refeeding syndrome in adults: A systematic review

Nutrition in the Neurocritically Ill Patient

Contact Info

Product

Resources

About