Contributing factors to hypophosphatemia development in critically Ill ventilated patients: a retrospective cohort study.
Fast
Hypophosphatemia
Refeeding syndrome
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
26 08 2024
26 08 2024
Historique:
received:
28
06
2023
accepted:
25
07
2024
medline:
27
8
2024
pubmed:
27
8
2024
entrez:
26
8
2024
Statut:
epublish
Résumé
Hypophosphatemia (serum phosphate < 2.5 mg/dL) is a major concern when initiating nutritional support. We evaluated which factors contribute to hypophosphatemia development in critically ill patients, as well as the association between hypophosphatemia and mortality. A retrospective cohort study of patients who were ventilated for at least 2 days in a 16-bed mixed ICU. Data collected includes demographics, Acute Physiology & Chronic Health Evaluation 2 (APACHE2) admission score, Sequential Organ Failure Assessment score at 24 h (SOFA24), hourly energy delivery, plasma phosphate levels during the first 2 weeks of admission, ICU length of stay (LOS), length of ventilation (LOV), and mortality (ICU and 90 days). For the hypophosphatemia development model, we considered mortality as a competing risk. For mortality analysis, we used the Cox proportional hazards model considering hypophosphatemia development as a time-varying covariate. 462 patients were used in the analysis. 59.52% of the patients developed hypophosphatemia. Several factors were associated with a decreased risk of hypophosphatemia: age, BMI, pre-admission diabetes diagnosis, APACHE2, SOFA24, first kidney SOFA score, hospital admission time before ICU admission, and admission after liver transplantation. Admission due to trauma was associated with an increased risk of hypophosphatemia. Survival analysis with hypophosphatemia as a time-varying covariate showed a protective effect of hypophosphatemia from mortality (HR 0.447, 95% CI 0.281, 0.712). Age, APACHE2, and SOFA24 score were found to be significantly associated with ICU mortality. Fasting duration in the ICU before nutritional support initiation was not found to be significantly associated with hypophosphatemia. We examined several fasting intervals (12 h, 24 h, 36 h, 48 h, 60 h, 72 h). In each fast interval, we compared the prevalence of hypophosphatemia among patients who fasted the specified length of time, with those who did not fast for the same length of time. In each fasting interval, hypophosphatemia prevalence was lower in the fasting group compared to the non-fasting group. However, this difference was insignificant. BMI, APACHE2, and hospital LOS before ICU admission were inversely associated with hypophosphatemia development. Fasting for up to 72 h in the ICU before starting nutritional support did not affect hypophosphatemia occurrence. Hypophosphatemia was associated with lower mortality.
Identifiants
pubmed: 39187535
doi: 10.1038/s41598-024-68688-x
pii: 10.1038/s41598-024-68688-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
19771Informations de copyright
© 2024. The Author(s).
Références
Marik, P. E. & Bedigian, M. K. Refeeding hypophosphatemia in critically ill patients in an intensive care unit. A prospective study. Arch. Surg. 131(10), 1043–1047 (1996).
doi: 10.1001/archsurg.1996.01430220037007
pubmed: 8857900
da Silva, J. S. V. et al. ASPEN consensus recommendations for refeeding syndrome. Nutr. Clin. Pract. 35(2), 178–195 (2020).
doi: 10.1002/ncp.10474
pubmed: 32115791
Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition. 2006 [updated 2017] [Internet]. National Institute for Health and Care Excellence; 2017 [cited 2023 Apr 4]. Available from: https://www.nice.org.uk/guidance/cg32
Rinninella, E. et al. Incidence and impact of refeeding syndrome in an internal medicine and gastroenterology ward of an Italian tertiary referral center: A prospective cohort study. Nutrients 14(7), 1343 (2022).
doi: 10.3390/nu14071343
pubmed: 35405956
pmcid: 9002385
Cioffi, I. et al. The incidence of the refeeding syndrome. A systematic review and meta-analyses of literature. Clin. Nutr. 40(6), 3688–3701 (2021).
doi: 10.1016/j.clnu.2021.04.023
pubmed: 34134001
Berger, M. M. et al. Prevalence of hypophosphatemia in the ICU—Results of an international 1-day point prevalence survey. Clin. Nutr. 40(5), 3615–3621 (2020).
doi: 10.1016/j.clnu.2020.12.017
pubmed: 33454128
Reintam Blaser, A. et al. Hypophosphatemia in critically ill adults and children—A systematic review. Clin. Nutr. 40(4), 1744–1754 (2020).
doi: 10.1016/j.clnu.2020.09.045
pubmed: 33268142
Friedli, N. et al. Revisiting the refeeding syndrome: Results of a systematic review. Nutrition. 35, 151–160 (2017).
doi: 10.1016/j.nut.2016.05.016
pubmed: 28087222
Sin, J. C. K. et al. Hypophosphatemia and outcomes in ICU: A systematic review and meta-analysis. J. Intensive Care Med. 12, 885066620940274 (2020).
Wang, L., Xiao, C., Chen, L., Zhang, X. & Kou, Q. Impact of hypophosphatemia on outcome of patients in intensive care unit: A retrospective cohort study. BMC Anesthesiol. 19(1), 86 (2019).
doi: 10.1186/s12871-019-0746-2
pubmed: 31122196
pmcid: 6533764
Hoffmann, M., Zemlin, A. E., Meyer, W. P. & Erasmus, R. T. Hypophosphataemia at a large academic hospital in South Africa. J. Clin. Pathol. 61(10), 1104–1107 (2008).
doi: 10.1136/jcp.2007.054940
pubmed: 18820097
Federspiel, C. K., Itenov, T. S., Thormar, K., Liu, K. D. & Bestle, M. H. Hypophosphatemia and duration of respiratory failure and mortality in critically ill patients. Acta Anaesthesiol. Scand. 62(8), 1098–1104 (2018).
doi: 10.1111/aas.13136
pubmed: 29687440
Cohen, J. et al. Hypophosphatemia following open heart surgery: Incidence and consequences. Eur. J. Cardio-Thoracic Surg. 26(2), 306–310 (2004).
doi: 10.1016/j.ejcts.2004.03.004
Mehanna, H. M., Moledina, J. & Travis, J. Refeeding syndrome: what it is, and how to prevent and treat it. BMJ. 336(7659), 1495–1498 (2008).
doi: 10.1136/bmj.a301
pubmed: 18583681
pmcid: 2440847
Kraft, M. D., Btaiche, I. F. & Sacks, G. S. Review of the refeeding syndrome. Nutr. Clin. Pract. 20(6), 625–633 (2005).
doi: 10.1177/0115426505020006625
pubmed: 16306300
Doig, G. S. et al. Restricted versus continued standard caloric intake during the management of refeeding syndrome in critically ill adults: A randomised, parallel-group, multicentre, single-blind controlled trial. Lancet Respir. Med. 3(12), 943–952 (2015).
doi: 10.1016/S2213-2600(15)00418-X
pubmed: 26597128
Lubart, E., Leibovitz, A., Dror, Y., Katz, E. & Segal, R. Mortality after nasogastric tube feeding initiation in long-term care elderly with oropharyngeal dysphagia—The contribution of refeeding syndrome. Gerontology. 55(4), 393–397 (2009).
doi: 10.1159/000218162
pubmed: 19420902
Dror, Y. et al. The impact of refeeding on blood fatty acids and amino acid profiles in elderly patients: A metabolomic analysis. JPEN J. Parenter. Enteral. Nutr. 37(1), 109–116 (2013).
doi: 10.1177/0148607112443260
pubmed: 22492466
Chen, L. J. Refeeding syndrome in Southeastern Taiwan: Our experience with 11 cases. WJG. 20(30), 10525 (2014).
doi: 10.3748/wjg.v20.i30.10525
pubmed: 25132771
pmcid: 4130862
Matthews-Rensch, K., Capra, S. & Palmer, M. Systematic review of energy initiation rates and refeeding syndrome outcomes. Nutr. Clin. Pract. 36(1), 153–168 (2021).
doi: 10.1002/ncp.10549
pubmed: 32794628
Statlender, L. et al. Correlations between first 72 h hypophosphatemia, energy deficit, length of ventilation, and mortality—A retrospective cohort study. Nutrients. 14(7), 1332 (2022).
doi: 10.3390/nu14071332
pubmed: 35405945
pmcid: 9002762
Knaus, W. A., Draper, E. A., Wagner, D. P. & Zimmerman, J. E. APACHE II: A severity of disease classification system. Crit. Care Med. 13(10), 818–829 (1985).
doi: 10.1097/00003246-198510000-00009
pubmed: 3928249
Ho, K. M. et al. Comparison of acute physiology and chronic health evaluation (APACHE) II score with organ failure scores to predict hospital mortality. Anaesthesia. 62(5), 466–473 (2007).
doi: 10.1111/j.1365-2044.2007.04999.x
pubmed: 17448058
Vincent, J. L. et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure: On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine (see contributors to the project in the appendix). Intensive Care Med. 22(7), 707–710 (1996).
doi: 10.1007/BF01709751
pubmed: 8844239
Fine, J. P. & Gray, R. J. A proportional hazards model for the subdistribution of a competing risk. J. Am. Stat. Assoc. 94(446), 496–509 (1999).
doi: 10.1080/01621459.1999.10474144
Austin, P. C., Latouche, A. & Fine, J. P. A review of the use of time-varying covariates in the Fine-Gray subdistribution hazard competing risk regression model. Stat. Med. 39(2), 103–113 (2020).
doi: 10.1002/sim.8399
pubmed: 31660633
Suzuki, S. et al. Hypophosphatemia in critically ill patients. J. Crit. Care. 28(4), 536.e9-536.e19 (2013).
doi: 10.1016/j.jcrc.2012.10.011
pubmed: 23265292
Miller, C. J. et al. Impact of serum phosphate in mechanically ventilated patients with severe sepsis and septic shock. J. Intensive Care Med. 35(5), 485–493 (2020).
doi: 10.1177/0885066618762753
pubmed: 29519205
Shor, R. et al. Severe hypophosphatemia in sepsis as a mortality predictor. Ann. Clin. Lab. Sci. 36(1), 67–72 (2006).
pubmed: 16501239
Olthof, L. E. et al. Impact of caloric intake in critically ill patients with, and without, refeeding syndrome: A retrospective study. Clin. Nutr. 37(5), 1609–1617 (2018).
doi: 10.1016/j.clnu.2017.08.001
pubmed: 28866139
Ananth, C. V. & Schisterman, E. F. Confounding, causality, and confusion: The role of intermediate variables in interpreting observational studies in obstetrics. Am. J. Obstet. Gynecol. 217(2), 167–175 (2017).
doi: 10.1016/j.ajog.2017.04.016
pubmed: 28427805
pmcid: 5545051
Coşkun, R., Gündoğan, K., Baldane, S., Güven, M. & Sungur, M. Refeeding hypophosphatemia: A potentially fatal danger in the intensive care unit. Turk. J. Med. Sci. 44, 369–374 (2014).
doi: 10.3906/sag-1211-49
pubmed: 25558635
Alsumrain, M. H. et al. Association of hypophosphatemia with failure-to-wean from mechanical ventilation. Ann. Clin. Lab. Sci. 40(2), 144–148 (2010).
pubmed: 20421625
Boateng, A. A., Sriram, K., Meguid, M. M. & Crook, M. Refeeding syndrome: Treatment considerations based on collective analysis of literature case reports. Nutrition. 26(2), 156–167 (2010).
doi: 10.1016/j.nut.2009.11.017
pubmed: 20122539
Bousie, E., Van Blokland, D., Lammers, H. J. W. & Van Zanten, A. R. H. Relevance of non-nutritional calories in mechanically ventilated critically ill patients. Eur. J. Clin. Nutr. 70(12), 1443–1450 (2016).
doi: 10.1038/ejcn.2016.167
pubmed: 27623980
pmcid: 5153455
Slingerland-Boot, R., Kummerow, M., Arbous, S. M. & Van Zanten, A. R. H. Association between first-week propofol administration and long-term outcomes of critically ill mechanically ventilated patients: A retrospective cohort study. Clin. Nutr. 43(1), 42–51 (2024).
doi: 10.1016/j.clnu.2023.10.029
pubmed: 38000194
Viana, M. V. et al. Specific nutrition and metabolic characteristics of critically ill patients with persistent COVID-19. J. Parenter Enteral. Nutr. 46(5), 1149–1159 (2022).
doi: 10.1002/jpen.2334