Characterizing the Clinical Impact of Refeeding Syndrome: Serum Phosphorus Decrement Does Not Impact Length of Stay (P12-038-19)

Abstract

ObjectivesRefeeding syndrome is characterized by rapid and severe hypokalemia, hypophosphatemia, hypomagnesemia, and/or Wernicke’s encephalitis occurring subsequent to reintroduction of calories, usually after prolonged starvation. These electrolyte decrements may lead to complications such as organ failure and death, which should be prevented with effective monitoring and supplementation. However, there is poor agreement on the definition of refeeding syndrome, limited understanding of its risk factors, and, unsurprisingly, poorly described patient outcomes. This pilot evaluation is part of an ongoing study seeking to better define the syndrome and elucidate predictive factors enabling preventive and treatment strategies and develop clear guidelines. MethodsA retrospective case-control study was performed at New York Presbyterian Hospital with inpatients admitted during 2015–2017. Patients with low levels of potassium, phosphorus, and/or magnesium within 3 days of the introduction of any oral, enteral, or parenteral source of calories were included. Type of diet and supplementation, demographics, nutritional history including weight change and intake, as well as comorbid conditions and medications, particularly those likely to cause alterations in electrolyte balance, as well as outcomes such as length of stay (LOS) and mortality were also noted for each admission. ResultsNearly 48,000 unique qualifying admissions were identified and verified with random quality checks. Preliminary results demonstrate a significant positive relationship between the degree of initial low magnesium or potassium level, but not with phosphorus, and length of stay. Magnesium values in the lowest third of low values had mean LOS 7.1, vs 6.3 days in those with highest levels (OR 1.18; 1.09–1.29). Low potassium values, by lowest to highest quartile, were associated with mean LOS of 7.0, 6.2, 6.1 days, vs. 4.7 days in those with the highest levels (OR 1.57 (1.47–1.68); 1.37 (1.28–1.45); 1.29 (1.21–1.37)). ConclusionsDespite identification in the literature of phosphorus as the prime component of refeeding syndrome, low levels had no impact on LOS, unlike magnesium and potassium. Next steps include comparison against a matched control group to identify factors that may increase refeeding syndrome risk. Funding SourcesNone.