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

IF 4.3 3区材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC ACS Applied Electronic Materials Pub Date : 2024-02-11 DOI:10.1002/jpen.2605

Nichakarn Apiromruck PharmD, BCP, Hasma Kano BSc, RD, Kittithat Taemkaew MD, Thammasin Ingviya MD, PhD, Utcharee Intusoma MD, PhD, Chaitong Churuangsuk MD, PhD

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Abstract

Background

Patients receiving parenteral nutrition (PN) may develop refeeding syndrome (RFS). This study determined RFS prevalence in hospitalized adults on PN and evaluated whether higher energy delivered by PN on day 1 of PN initiation was associated with RFS development.

Methods

We reviewed the medical records of adult patients receiving PN at a Thai quaternary hospital from June 2019 to May 2022. RFS was defined based on the Nutrition Management Clinical Practice Recommendation by the Society of Parenteral and Enteral Nutrition of Thailand. The association between PN energy delivery and RFS development was determined using a generalized estimating equation for multiple logistic regression analysis adjusted for NICE guideline risk factors.

Results

A total of 547 patients was included (mean age 59.8 ± 17.2 years, mean body mass index 20.7 ± 4.8 ). The prevalence of RFS was 45%. Factors associated with RFS included energy from PN on the first day of PN initiation (adjusted odds ratio [aOR] 1.17; 95% CI 1.04–1.33; for every 5 kcal/kg/day increase), starvation >5 days prior to PN (aOR 1.54; 95% CI 1.04–2.26), concomitant diuretic use (aOR 1.81; 95% CI 1.25–2.64), low baseline potassium level (aOR 1.79; 95% CI 1.19–2.70), and individual compounding PN (aOR 1.61; 95% CI 1.04–2.51).

Conclusion

RFS was common among hospitalized patients receiving PN. The amount of energy delivered on the first day of PN was independently associated with RFS, raising a concern regarding initiation of PN with higher energy.

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住院成人肠外营养能量输送与反食综合征之间的关系：一项回顾性队列研究。

背景：接受肠外营养（PN）的患者可能会出现再喂养综合征（RFS）。本研究确定了接受肠外营养的住院成人中 RFS 的发生率，并评估了肠外营养开始第一天提供的较高能量是否与 RFS 的发生有关：我们回顾了泰国一家四级医院在2019年6月至2022年5月期间接受PN治疗的成人患者的医疗记录。RFS的定义基于泰国肠外和肠内营养学会的营养管理临床实践建议。采用广义估计方程进行多元逻辑回归分析，并根据 NICE 指南的风险因素进行调整，确定 PN 能量输送与 RFS 发展之间的关系：共纳入 547 名患者（平均年龄为 59.8 ± 17.2 岁，平均体重指数为 20.7 ± 4.8）。RFS发病率为45%。与 RFS 相关的因素包括开始 PN 的第一天来自 PN 的能量（调整赔率 [aOR] 1.17；95% CI 1.04-1.33；每增加 5 千卡/千克/天）、PN 前 5 天以上的饥饿（aOR 1.54；95% CI 1.04-2.26）、同时使用利尿剂（aOR 1.81；95% CI 1.25-2.64）、低基线血钾水平（aOR 1.79；95% CI 1.19-2.70）和个人复方 PN（aOR 1.61；95% CI 1.04-2.51）：结论：RFS在接受PN的住院患者中很常见。结论：在接受 PN 的住院病人中，RFS 很常见。PN 第一天提供的能量与 RFS 无关，这引起了人们对开始使用高能量 PN 的关注。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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