Refeeding Syndrome in Patients Receiving Parenteral Nutrition Is Not Associated to Mortality or Length of Hospital Stay: A Retrospective Observational Study

Abstract

Background Refeeding syndrome (RS) is characterized by severe electrolyte derangement that may be associated with worse clinical outcomes in hospitalized patients. In this study, we aim to assess the incidence of RS in inpatients receiving parenteral nutrition (PN) and its possible association with the length of hospital stay (LHS) and mortality. Methods We conducted a historical cohort study involving adults receiving PN, monitored by a nutrition therapy team in a Brazilian public hospital. Data collection was made from electronic records. We assessed the presence of RS after PN therapy was initiated. The amount of energy delivered within 72 hours of PN, LHS, and mortality were compared between patients with and without RS. Results One‐hundred ninety‐seven patients (aged 57.7 ± 14.1 years; 55.7% men) were followed for a median of 51 days. The incidence of RS was equal to 25.4%. The adequacy of energy delivered in relation to energy requirements within 72 hours (69.4% ± 29.3% vs 61.8% ± 21.6%) was higher in patients with RS than in those without RS (P = .054). The incidence of death was 55.3% and did not differ between groups. The median of LHS was equal to 51.0 (32.0–83.0) days, and it also did not differ between patients with and without RS. Conclusion RS was identified in 25% of patients receiving PN, but it was not associated to mortality and LHS, even when energy delivery was considered in combination to RS.

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

“…Meira et al conducted a retrospective cohort study in 197 patients to explore diagnostic criteria for RFS. 22 RFS was defined as a drop in any two serum electrolytes below predefined cutoffs for the reference range (potassium <3.5 mmol/L, phosphorous <0.8 mmol/L, or magnesium <0.7 mmol/L) or a relative decline of >30% in serum phosphate from baseline, or a drop in serum phosphorous below 0.6 mmol/L. This comprehensive definition combines the characteristics of several of our study definitions.…”

Association between energy delivery from parenteral nutrition and refeeding syndrome in hospitalized adults: A retrospective cohort study

“…However, to our knowledge, only one study has used these diagnostic criteria for RFS in patients receiving PN. 18 Knowing the factors associated with RFS helps us better understand the pathophysiology and mechanism of RFS and identify patients who may be at risk. According to the National Institute for Health and Care Excellence (NICE) guidelines, 19 patients are considered at risk of RFS if they have one or more of the following: body mass index (BMI) <16 (calculated as weight in kilograms divided by height in meters squared), unintentional weight loss of >15% in the past 3-6 months, little or no nutrition intake for >10 days, or low levels of potassium, phosphate, or magnesium before feeding.…”

“…Limited evidence showed that high energy delivered from PN, especially on the first day of PN use, after a fasting period is likely associated with the development of RFS. 16,18 Thus, this study aimed to determine the prevalence of RFS in hospitalized adults receiving PN using the diagnostic criteria of Friedli et al 17 and to evaluate our hypothesis whether a higher amount of energy delivered by PN on day 1 of PN initiation (exposure of interest) is associated with the development of RFS (primary outcome). We also evaluated the association between common risk factors as stated in the NICE guidelines and the development of RFS.…”

“…On the other hand, manifest RFS was considered if any electrolyte shifts occur in conjunction with typical clinical symptoms of RFS. However, to our knowledge, only one study has used these diagnostic criteria for RFS in patients receiving PN 18 …”

Energy Guidance Using Indirect Calorimetry for Intestinal Failure Patients with Home Parenteral Nutrition: The Right Bag Right at the Start

“…One of the most challenging features of HPN treatment is the search for a well-tolerated PN mixture that fulfils the nutritional requirements [ 3 ], next to minimizing and preventing PN complications such as refeeding syndrome (RFS) and catheter-related bloodstream infections (CRBSI) [ 4 ]. In particular, parenteral nutrition-associated liver disease (PNALD) and the occurrence of hyperglycemia can be life-threatening and are associated with macronutrient dosing [ 5 , 6 , 7 ]. The recommendations by the European Society of Clinical Nutrition and Metabolism (ESPEN) state an individualized assessment is essential [ 8 ] in order to develop a nutritional plan because of an alteration in metabolism due to IF.…”