Refeeding Syndrome as a Possible Cause of Very Early Mortality in Acute Pancreatitis
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Background/Aims: Refeeding syndrome (RFS) is a fatal clinical complication that can occur as a result of fluid and electrolyte shifts during early nutritional rehabilitation for malnourished patients. This study was conducted to determine the clinical implications of RFS in patients with acute pancreatitis (AP). Methods: Between 2006 and 2016, AP patients with very early mortality were retrospectively enrolled from three university hospitals. Results: Among 3,206 patients with AP, 44 patients died within 3 days after diagnosis. The median age was 52.5 years (range, 27 to 92 years), male-to-female ratio was 3:1, and median duration from admission to death was 33 hours (range, 5 to 72 hours). The etiology of AP was alcohol abuse in 32 patients, gallstones in five patients, and hypertriglyceridemia in two patients. Ranson score, bedside index for severity of AP, and acute physiology and chronic health evaluation-II were valuable for predicting very early mortality (median, [range]; 5 [1 to 8], 3 [0 to 5], and 19 [4 to 45]). RFS was diagnosed in nine patients who died of septic shock (n=5), cardiogenic shock (n=2), or cardiac arrhythmia (n=2). In addition, patients with RFS had significant hypophosphatemia compared to non-RFS patients (2.6 mg/dL [1.3 to 5.1] vs 5.8 mg/dL [0.8 to 15.5]; p=0.001). The early AP-related mortality rate within 3 days was approximately 1.4%, and RFS occurred in 20.5% of these patients following sudden nutritional support. Conclusions: The findings of current study emphasize that clinicians should be aware of the possibility of RFS in malnourished AP patients with electrolyte imbalances.
Abstract
Background/Aims: Refeeding syndrome (RFS) is a fatal clinical complication that can occur as a result of fluid and electrolyte shifts during early nutritional rehabilitation for malnourished patients. This study was conducted to determine the clinical implications of RFS in patients with acute pancreatitis (AP). Methods: Between 2006 and 2016, AP patients with very early mortality were retrospectively enrolled from three university hospitals. Results: Among 3,206 patients with AP, 44 patients died within 3 days after diagnosis. The median age was 52.5 years (range, 27 to 92 years), male-to-female ratio was 3:1, and median duration from admission to death was 33 hours (range, 5 to 72 hours). The etiology of AP was alcohol abuse in 32 patients, gallstones in five patients, and hypertriglyceridemia in two patients. Ranson score, bedside index for severity of AP, and acute physiology and chronic health evaluation-II were valuable for predicting very early mortality (median, [range]; 5 [1 to 8], 3 [0 to 5], and 19 [4 to 45]). RFS was diagnosed in nine patients who died of septic shock (n=5), cardiogenic shock (n=2), or cardiac arrhythmia (n=2). In addition, patients with RFS had significant hypophosphatemia compared to non-RFS patients (2.6 mg/dL [1.3 to 5.1] vs 5.8 mg/dL [0.8 to 15.5]; p=0.001). The early AP-related mortality rate within 3 days was approximately 1.4%, and RFS occurred in 20.5% of these patients following sudden nutritional support. Conclusions: The findings of current study emphasize that clinicians should be aware of the possibility of RFS in malnourished AP patients with electrolyte imbalances.
참고문헌 (29)
- Lee KJ, "Comparison of predictive systems in severe acute pancreatitis according to the revised Atlanta classification", Pancreas, 45, pp.46~50 (2016)
- Cho JH, "Usefulness of scheduled followup CT in discharged patients with acute pancreatitis", Pancreatology, 15, pp.642~646 (2015)
- Valverde-López F, "BISAP, RANSON, lactate and others biomarkers in prediction of severe acute pancreatitis in a European cohort", J Gastroenterol Hepatol, 32, pp.1649~1656 (2017)
- Crook MA, "The importance of the refeeding syndrome", Nutrition, 17, pp.632~637 (2001)
- Mehanna H, "Refeeding syndrome : awareness, prevention and management", Head Neck Oncol, 1, pp.4~ (2009)
- Dunn RL, "Refeeding syndrome in hospitalized pediatric patients", Nutr Clin Pract, 18, pp.327~332 (2003)
- Fuentebella J, "Refeeding syndrome", Pediatr Clin North Am, 56, pp.1201~1210 (2009)
- Solomon SM, "The refeeding syndrome : a review", JPEN J Parenter Enteral Nutr, 14, pp.90~97 (1990)
- Katzman DK, "Refeeding hospitalized adolescents with anorexia nervosa : is"start low, advance slow"urban legend or evidence based", J Adolesc Health, 50, pp.1~2 (2012)
- Fernández López MT, "Refeeding syndrome", Farm Hosp, 33, pp.183~193 (2009)
- Kraft MD, "Review of the refeeding syndrome", Nutr Clin Pract, 20, pp.625~633 (2005)
- Khan LU, "Refeeding syndrome : a literature review", Gastroenterol Res Pract, 2011, pp.410971~ (2011)
- Gianotti L, "ESPEN guidelines on parenteral nutrition : pancreas", Clin Nutr, 28, pp.428~435 (2009)
- Banks PA, "Practice guidelines in acute pancreatitis", Am J Gastroenterol, 101, pp.2379~2400 (2006)
- Gentile MG, "Specialized refeeding treatment for anorexia nervosa patients suffering from extreme undernutrition", Clin Nutr, 29, pp.627~632 (2010)
- Webb GJ, "Complications of emergency refeeding in anorexia nervosa : case series and review", Acute Med, 10, pp.69~76 (2011)
- Sachs K, "Avoiding medical complications during the refeeding of patients with anorexia nervosa", Eat Disord, 23, pp.411~421 (2015)
- Friedli N, "Revisiting the refeeding syndrome : results of a systematic review", Nutrition, 35, pp.151~160 (2017)
- "Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition (CG32)" (2006)[URL]
- Rio A, "Occurrence of refeeding syndrome in adults started on artificial nutrition support : prospective cohort study", BMJ Open, 3, pp.e002173~ (2013)
- Mehanna HM, "Refeeding syndrome : what it is, and how to prevent and treat it", BMJ, 336, pp.1495~1498 (2008)
- Veverbrants E, "Effects of fasting and refeeding. I. Studies on sodium, potassium and water excretion on a constant electrolyte and fluid intake", J Clin Endocrinol Metab, 29, pp.55~62 (1969)
- Preiser JC, "Metabolic and nutritional support of critically ill patients : consensus and controversies", Crit Care, 19, pp.35~ (2015)
- Silvis SE, "Paresthesias, weakness, seizures, and hypophosphatemia in patients receiving hyperalimentation", Gastroenterology, 62, pp.513~520 (1972)
- Hernández-Aranda JC, "Malnutrition and total parenteral nutrition : a cohort study to determine the incidence of refeeding syndrome", Rev Gastroenterol Mex, 62, pp.260~265 (1997)
- Hayek ME, "Severe hypophosphatemia following the institution of enteral feedings", Arch Surg, 124, pp.1325~1328 (1989)
- Hearing SD, "Refeeding syndrome", BMJ, 328, pp.908~909 (2004)
- Marik PE, "Refeeding hypophosphatemia in critically ill patients in an intensive care unit : a prospective study", Arch Surg, 131, pp.1043~1047 (1996)
- Nunes G, "Refeeding syndrome in the gastroenterology practice : how concerned should we be", Eur J Gastroenterol Hepatol, 30, pp.1270~1276 (2018)