The Incidence And Risk Factors Of Hypophosphatemia In Enterally Fed Patients In The Neurologic Intensive Care Unit

Objective:1.To analyze the occurrence of hypophosphatemia and its effect on prognosis in patients receiving enteral nutrition in the Neurologic Intensive Care Unit.2.To investigate the risk factors of hypophosphatemia in patients receiving enteral nutrition in the Neurologic Intensive Care Unit,so as to achieve early prevention and improve the prognosis.Methods:A retrospective study was conducted for 92 patients,who were admitted to the department of Neurology Intensive Care Unit,from September 2015 to November 2017.The patients were divided into hypophosphatemia group and normal phosphorus group according to serum phosphorus levels.The hypophosphatemia group was categorized as mild and moderate-severe groups(normal value of the serum phosphate level is 0.80 to1.45mmol/L,mild values of the serum phosphate level is 0.65 to 0.80mmol/L,moderate-severe values of the serum phosphate level is less than 0.65 mmol/ L).The changes in serum electrolyte levels(phosphorus,potassium,magnesium,calcium,and sodium)in patients with hypophosphatemia were dynamically examined.Acute physiology and chronic health evaluation II(APACHE II)score,duration of EN,duration of use of ventilator,length of NICU-stay and mortality were compared among patients with different phosphorus levels.Some relevant factors were obtained according to medical record,including the general characteristics of the patients(name,age,gender,admission diagnosis),the past medical history(hypertension,diabetes,coronary heart disease,smoking and drinking),the main laboratory parameters(serum sodium,potassium,calcium,magnesium,creatinine,urea nitrogen,prealbumin,albumin)before EN,the time of anorexia in patients before EN,Nutrition Risk Screening score at admission(NRS-2002),the amount of calories in the first day' s EN regiment,and acute physiology and chronic health evaluation II(APACHE II).Finally,risk factors were analyzed by using multivariate logistic regression.Results:1.The prevalance of hypophosphatemia was 48.9%(45 of 92 patients)among enterally fed patients in NICU.Of the patients with hypophosphatemia,there were 23 mild cases and 22 moderate-severe cases..The serum phosphorus level of patients with hypophosphatemia in NICU began to decline on the first day of EN regiment,reached the lowest level on the third day,and gradually returned to normal value after supplementation.2.The APACHE II score of the mild group was higher compared with that of the normal group(P<0.05).The APACHEII score,duration of EN,duration of use of ventilator,length of NICU-stay and mortality of the moderate-severe group were significantly higher than those of the normal group(P<0.05).There was no significant difference between mild and moderate-severe patients(P>0.05).3.Multivariate logistic regression showed that hypokalemia(OR=4.512,95 %CI:1.085-18.759,P=0.038),low serum prealbumin(OR=2.667,95%CI:1.015-7.007,P=0.047),and high APACHEII score(OR=2.497,95%CI: 1.177-5.297,P=0.017)were risk factors of hypophosphatemia.Conclusion:1.Patients who were enterally fed in NICU are susceptible to suffer from hypophosphatemia.Moderate-severe hypophosphatemia may mean unfavorable prognosis.2.The serum phosphorus usually begins to decline on the first day of enteralnutrition regiment in patients received enteral nutrition in NICU,and falls to the lowest point on the third day.The serum phosphorus gradually returns to normal level after phosphorus supplementation.3.Hypokalemia,low serum prealbumin and high APACHEII score are independent risk factors for hypophosphatemia in enterally fed patients in NICU.