Department of Medicine, University of Colorado Denver, Denver, Colorado.
ACUTE Center for Eating Disorders and Division of Hospital Medicine, ACUTE Center for Eating Disorders and Division of Hospital Medicine, Denver, Colorado.
Int J Eat Disord. 2015 Nov;48(7):898-904. doi: 10.1002/eat.22406. Epub 2015 Apr 2.
Hypophosphatemia of refeeding is one of the most dangerous complications seen during the treatment of patients with anorexia nervosa. Although easily detectable and treatable, hypophosphatemia is under-recognized as a complication of refeeding. Specific risk factors for the development of hypophosphatemia are likely to exist among patients with severe anorexia nervosa. The purpose of this study was to identify clinically useful markers that may predict the development of or protection from hypophosphatemia during refeeding.
We conducted a retrospective case-control study of 123 patients with severe anorexia nervosa admitted for medical stabilization at the ACUTE Center for Eating Disorders between October 1, 2008 and December 31, 2013. Risk factors for refeeding hypophosphatemia were determined by multivariate logistic regression from clinical parameters and laboratory values measured at the time of admission.
The prevalence of hypophosphatemia was 33.3% (41 of 123 patients). Higher hemoglobin was the only risk factor associated with a higher odds of developing hypophosphatemia (adjusted odds ratio [aOR], 1.56 [95% confidence interval [CI], 1.12-2.18]). Statistically significant protective factors against the development of hypophosphatemia were observed with higher body mass index (aOR, 0.54 [95% CI, 0.39-0.75]), higher serum potassium (aOR, 0.29 [95% CI, 0.14-0.62]), and higher serum prealbumin (aOR, 0.91 [95% CI, 0.84-0.99]).
Four independent factors associated with refeeding hypophosphatemia were identified. Identification of findings which correlate with hypophosphatemia, or the lack thereof, has the potential to facilitate appropriate triage of patients with anorexia nervosa for closer monitoring during refeeding.
再喂养性低磷血症是厌食症患者治疗过程中最危险的并发症之一。尽管这种并发症很容易被发现和治疗，但它仍未被充分认识为再喂养的并发症之一。严重厌食症患者中可能存在发生再喂养性低磷血症的特定危险因素。本研究旨在确定可能预测再喂养期间发生或预防低磷血症的临床有用标志物。
我们对 2008 年 10 月 1 日至 2013 年 12 月 31 日期间在 ACUTE 进食障碍中心接受医学稳定治疗的 123 例严重厌食症患者进行了回顾性病例对照研究。通过多变量逻辑回归，从入院时的临床参数和实验室值中确定再喂养性低磷血症的危险因素。
低磷血症的患病率为 33.3%（123 例患者中有 41 例）。较高的血红蛋白是唯一与发生低磷血症的几率较高相关的危险因素（调整后的优势比 [aOR]，1.56[95%置信区间 [CI]，1.12-2.18]）。较高的体重指数（aOR，0.54[95%CI，0.39-0.75]）、较高的血清钾（aOR，0.29[95%CI，0.14-0.62]）和较高的血清前白蛋白（aOR，0.91[95%CI，0.84-0.99]）是发生低磷血症的统计学显著保护因素。
确定了与再喂养性低磷血症相关的四个独立因素。发现与低磷血症相关或不相关的发现，有可能促进对厌食症患者进行适当的分诊，以便在再喂养期间进行更密切的监测。
