Risk Factors Of ICU Refeeding Syndrome And The Correlation Between Electrolyte Changes And Prognosis

Objective:To investigate the early risk factors of refeeding syndrome(RFS)after initial feeding in ICU patients directly admitted to ICU for the first time,and to construct a prediction model,so as to provide a reference for the selection of nutritional strategies for critically ill patients in the early admission period.Methods:The medical records of patients who were admitted to ICU of the First Affiliated Hospital of Bengbu Medical College for the first time from January 1,2020 to July 31,2021 and met the criteria for case inclusion were analyzed retrospectively.According to the diagnosis of RFS or not,the patients were divided into RFS group and non-RFS group.The clinical data indicators of the two groups were analyzed and compared,and the early prediction model of RFS was constructed.Results:Total of 200 cases were included in the analysis,including 134 cases in the RFS group and 66 cases in the non-RFS group.Univariate analysis showed that NRS2002 and APACHEII score,Whether sepsis was diagnosed within 3 days of admission,history of insulin use within 3 days,prealbumin,urea nitrogen and C-reactive protein were correlated with RFS(P<0.05).Binary logistic regression analysis showed that prealbumin,urea nitrogen and C-reactive protein were independent risk factors for RFS(P<0.05).The early RFS prediction model Logit(P)=0.114X1+0.011X2-0.005X3 was constructed.The area under the ROC curve of the model to predict the incidence of RFS in critically ill patients was 0.742(95%CI:0.6708-0.8132),the sensitivity was 81.34%,and the specificity was 57.58%.The goodness of fit of the model showed that χ2=3.808(P>0.05).Conclusion:The critically ill patients with hepatic and renal insufficiency who were excluded from the initial admission had a higher incidence of RFS than those who were not excluded after the first feeding,and the impairment of organ function inhibited the decline of electrolyte levels.Prealbumin,urea nitrogen and C-reactive protein are risk factors that can be obtained in the early stage of critically ill patients.The RFS risk prediction model based on this has a good discrimination and calibration degree,which can effectively assess the risk of RFS in critically ill patients,and provide reference for physicians to choose nutrition strategies.Objective:To thoroughly examine the electrolyte changes and its correlation with short-term prognosis of adult patients with refeeding syndrome(RFS)after initial feeding in intensive care unit(ICU)wards of the grade A general hospital.Methods:A retrospective research has been conducted on 193 critically-ill adult patients with malnutrition risk and the absence of moderate to severe liver and kidney function injury who have been first admitted to the ICU of our hospital on 1st January 2020 to 31st July 2021.Subsequently,according to the traditional diagnostic criteria of RFS,there are 129 diagnosed cases in the RFS group and 64 diagnosed cases in the non-RFS group.Compared to two groups of patients with electrolyte change and short-term prognosis,and analyze the electrolyte change’s ability to distinguish between short-term prognosis of patients.Results:There are no significant differences observed between the RFS group and NRFS group in terms of gender and 28 days of acute liver injury(P>0.05).Concurrently,there are significant differences observed between the RFS group and NRFS group in age,28 days of acute kidney injury,28 days of newly supplemented mechanical ventilation,length of stay in ICU,28 days mortality rate,28 days turnover rate and various other prognostic indicators(P<0.05).In addition,before and after feeding,among various electrolytes,only free blood phosphorus level in both the RFS group and NRFS group satisfied the normal distribution(P>0.05).Simultaneously,after feeding(0.639±0.284)in the RFS group has been significantly lower as compared to before feeding(1.130 ± 0.292)(P<0.05).Furthermore,the binary logistic regression analysis has also presented that the lowest value of blood phosphorus within 3 days after feeding has been significantly correlated with the prognosis of patients within 28 days(P<0.05).However,the decrease of serum phosphorus was not related to it(P>0.05).At the same time,the ROC curve analysis has also demonstrated that the area under the curve of the lowest value of blood phosphorus within three days after feeding is at 0.679,and the 95%CI is at(0.6479 to 0.8043).Additionally,the maximum cutoff value of the Jordan index of the lowest value of blood phosphorus within 3 days is 0.675mmol/L.Subsequently,a brand-new subgroup has been established with parameters P≤0.675mmol/L after feeding.When compared with the traditional RFS diagnostic subgroup,the new subgroup has demonstrated a smaller positive diagnostic range(75/129),and the ability to distinguish the short-term prognosis of patients is better than traditional subgroup.Conclusion:In critically ill patients,blood phosphate has better stability than other electrolytes,and hypophosphatemia based on feeding alone has better discrimination of short-term prognosis than the traditional RFS diagnostic method.Only by virtue of hypophosphatemia after feeding may be the preferred direction for the diagnosis of RFS in critically ill patients.