Refeeding syndrome is associated with increased mortality in malnourished medical inpatients: Secondary analysis of a randomized trial.

Friedli, Natalie; Baumann, Jessica; Hummel, Ramona; Kloter, Milena; Odermatt, Jonas; Fehr, Rebecca; Felder, Susan; Baechli, Valerie; Geiser, Martina; Deiss, Manuela; Tribolet, Pascal; Gomes, Filomena; Mueller, Beat; Stanga, Zeno; Schuetz, Philipp (2020). Refeeding syndrome is associated with increased mortality in malnourished medical inpatients: Secondary analysis of a randomized trial. Medicine, 99(1), e18506. Lippincott Williams & Wilkins 10.1097/MD.0000000000018506

Preview

Text Refeeding_syndrome_is_associated_with_increased.22.pdf - Published Version Available under License Creative Commons: Attribution-Noncommercial (CC-BY-NC). Download (426kB) | Preview

BACKGROUND

Whether the occurrence of refeeding syndrome (RFS), a metabolic condition characterized by electrolyte shifts after initiation of nutritional therapy, has a negative impact on clinical outcomes remains ill-defined. We prospectively investigated a subgroup of patients included in a multicentre, nutritional trial (EFFORT) for the occurrence of RFS.

METHODS

In this secondary analysis of a randomized-controlled trial investigating the effects of nutritional support in malnourished medical inpatients, we prospectively screened patients for RFS and classified them as "RFS confirmed" and "RFS not confirmed" based on predefined criteria (i.e. electrolyte shifts, clinical symptoms, clinical context, and patient history). We assessed associations of RFS and mortality within 180 days (primary endpoint) and other secondary endpoints using multivariable regression analysis.

RESULTS

Among 967 included patients, RFS was confirmed in 141 (14.6%) patients. Compared to patients with no evidence for RFS, patients with confirmed RFS had significantly increased 180-days mortality rates (42/141 (29.8%) vs 181/826 (21.9%), adjusted odds ratio (OR) 1.53 (95% CI 1.02 to 2.29), P < .05). Patients with RFS also had an increased risk for ICU admission (6/141 (4.3%) vs 13/826 (1.6%), adjusted OR 2.71 (95% CI 1.01 to 7.27), P < .05) and longer mean length of hospital stays (10.5 ± 6.9 vs 9.0 ± 6.6 days, adjusted difference 1.57 days (95% CI 0.38-2.75), P = .01).

CONCLUSION

A relevant proportion of medical inpatients with malnutrition develop features of RFS upon hospital admission, which is associated with long-term mortality and other adverse clinical outcomes. Further studies are needed to develop preventive strategies for RFS in this patient population.

Interest & Impact

Downloads

97 since deposited on 13 Jan 2021
32 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item