Zhang Wei, Zhang Sheng-Xiang, Chen Shu-Fan, Yu Tao, Tang Yun
Department of Neurosurgery Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, China.
Department of Nursing, Soochow University, Suzhou, China.
Front Nutr. 2023 Feb 15;10:1083483. doi: 10.3389/fnut.2023.1083483. eCollection 2023.
The incidence of refeeding syndrome (RFS) in critically ill patients is high, which is detrimental to their prognoses. However, the current status and risk factors for the occurrence of RFS in neurocritical patients remain unclear. Elucidating these aspects may provide a theoretical basis for screening populations at high risk of RFS.
A total of 357 patients from January 2021 to May 2022 in a neurosurgery ICU of a tertiary hospital in China were included using convenience sampling. Patients were divided into RFS and non-RFS groups, based on the occurrence of refeeding-associated hypophosphatemia. Risk factors for RFS were determined using univariate and logistic regression analyses, and a risk prediction model for RFS in neurocritical patients was developed. The Hosmer-Lemeshow test was used to determine the goodness of fit of the model, and the receiver operator characteristic curve was used to examine its discriminant validity.
The incidence of RFS in neurocritical patients receiving enteral nutrition was 28.57%. Logistic regression analyses showed that history of alcoholism, fasting hours, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, Sequential Organ Failure Assessment (SOFA) scores, low serum albumin, and low baseline serum potassium were risk factors of RFS in neurocritical patients ( < 0.05). The Hosmer-Lemeshow test showed = 0.616, and the area under the ROC curve was 0.791 (95% confidence interval: 0.745-0.832). The optimal critical value was 0.299, the sensitivity was 74.4%, the specificity was 77.7%, and the Youden index was 0.492.
The incidence of RFS in neurocritical patients was high, and the risk factors were diverse. The risk prediction model in this study had good predictive effects and clinical utility, which may provide a reference for assessing and screening for RFS risk in neurocritical patients.
重症患者中再喂养综合征（RFS）的发生率很高，这对其预后不利。然而，神经重症患者发生RFS的现状及危险因素仍不明确。阐明这些方面可为筛查RFS高危人群提供理论依据。
采用方便抽样法纳入2021年1月至2022年5月在中国一家三级医院神经外科重症监护病房（ICU）的357例患者。根据再喂养相关低磷血症的发生情况，将患者分为RFS组和非RFS组。采用单因素和逻辑回归分析确定RFS的危险因素，并建立神经重症患者RFS的风险预测模型。采用Hosmer-Lemeshow检验确定模型的拟合优度，采用受试者工作特征曲线检验其判别效度。
接受肠内营养的神经重症患者中RFS的发生率为28.57%。逻辑回归分析显示，酗酒史、禁食时间、急性生理与慢性健康状况评分系统II（APACHE II）评分、序贯器官衰竭评估（SOFA）评分、低血清白蛋白和低基线血清钾是神经重症患者发生RFS的危险因素（<0.05）。Hosmer-Lemeshow检验显示=0.616，ROC曲线下面积为0.791（95%置信区间：0.745-0.832）。最佳临界值为0.299，灵敏度为74.4%，特异度为77.7%，约登指数为0.492。
神经重症患者中RFS的发生率较高，且危险因素多样。本研究中的风险预测模型具有良好的预测效果和临床实用性，可为评估和筛查神经重症患者的RFS风险提供参考。
