再喂养综合征和血磷水平变化对急危重症患者短期预后的预测能力比较

To assess the predictive efficacy of refeeding syndrome and serum phosphorus changes in short-term prognosis among critically ill patients

目的探究成人急危重症患者初次喂养后发生再喂养综合征(refeeding syndrome,RFS)对短期预后的影响,并与血磷水平变化对急危重症患者预后的预测能力进行比较。方法回顾性收集2020年1月1日至2021年7月31日首次收住我院重症医学科存在营养不良风险且不合并中重度肝肾功能损伤的成人急危重症患者193例。依据传统再喂养综合征诊断标准分为RFS组(n=129)和非再喂养综合征(NRFS组,n=64),对比两组患者电解质水平变化及短期预后情况,并分析血磷水平变化与预后的相关性。结果RFS组和NRFS组年龄、28 d急性肾功能损伤、28 d新增机械通气、ICU住院时间、28 d病死率、28 d转出率等预后指标差异有统计学意义(P<0.05)。RFS组喂养后血磷水平较喂养前显著下降(mmol/L:0.64±0.28 vs.1.13±0.29,P<0.05)。二元Logistic回归分析显示,喂养后3 d内血磷最低值与28 d内患者转出预后呈显著相关(P<0.05),血磷下降幅度则与28 d内患者转出预后不相关(P>0.05)。ROC曲线分析显示,喂养后3 d内血磷最低值曲线下面积为0.679,95%CI为0.6479~0.8043。3 d内血磷最低值的约登指数最大截断值为0.675 mmol/L。以喂养后血磷≤0.675 mmol/L建立新分组,新分组对急危重症患者短期预后预测能力的约登指数均高于传统RFS分组(P<0.05)。结论成人急危重症患者并发RFS产生不良的短期临床预后。喂养后低血磷水平对急危重症患者短期预后的预测价值优于传统RFS诊断分组。

Objective To analyze and compare the predictive value of refeeding syndrome(RFS)and serum phosphorus levels on short-term prognosis in adult patients after initial feeding in intensive care unit(ICU)wards of a grade A general hospital.Methods A retrospective research had been conducted in 193 critically ill adult patients with malnutrition risk and the absence of moderate to severe liver and kidney function injury who had been first admitted to the ICU of our hospital on January 1,2020 to July 31,2021.Subsequently,according to the traditional diagnostic criteria of RFS,the participants were divided into two groups:RFS group(n=129)and non-refeeding syndrome(NRFS)group(n=64).The electrolyte changes and short-term prognosis in two groups were compared,and the association between the alterations in serum phosphorus levels and short-term prognosis was analyzed.Results There were significant differences in age,28-day acute kidney injury,28-day newly supplemented mechanical ventilation,length of stay in ICU,28-day mortality rate,28-day turnover rate between the RFS group and NRFS group(P<0.05).Blood phosphorus level after feeding was significantly lower than that before feeding in the RFS group(mmol/L:0.64±0.28 vs.1.13±0.29,P<0.05).Furthermore,the binary Logistic regression analysis showed that the lowest value of blood phosphorus within 3 days after feeding was significantly correlated with the prognosis of patients within 28 days(P<0.05).However,the decrease amplitude of serum phosphorus was not related to the prognosis of patients within 28 days(P>0.05).At the same time,the ROC curve analysis showed that the area under the curve of the lowest value of blood phosphorus within three days after feeding was 0.679,and 95%CI was 0.6479 to 0.8043.Additionally,the maximum cutoff value of the Jordan index of the lowest value of blood phosphorus within 3 days was 0.675 mmol/L.Subsequently,a brand-new subgroup has been established with blood phosphorus≤0.675 mmol/L after feeding.The electrolyte changes and short-term prognosis in two groups were compared,and the association between the alterations in serum phosphorus levels and short-term prognosis was analyzed.The ability of the new subgroup to distinguish the short-term prognosis of patients is better than that of the traditional RFS diagnostic subgroup.Conclusion Patients diagnosed with RFS during hospitalization in critically ill adults have poor short-term clinical outcomes.The predictive value of low serum phosphorus levels in the short-term prognosis of critically ill patients is superior to that of the traditional RFS diagnostic group after feeding.