Occurrence and predictors of refeeding syndrome in adult patients receiving parenteral nutrition at a Malaysian teaching hospital: A retrospective study.

Abstract

Background and objectives: Refeeding syndrome (RS) is a potentially life-threatening condition character-ised by significant electrolyte and fluid imbalances, posing a considerable risk in patients undergoing parenteral nutrition (PN) therapy. This study aimed to determine the occurrence, risk factors, severity, and complications of RS in a teaching hospital in Malaysia.

Methods and study design: A retrospective observational study was conducted using universal sampling from October to December 2023. Data were collected for adult patients receiving PN for more than 48 hours between July 2022 and July 2023 at Hospital Canselor Tuanku Muhriz.

Results: Among 90 patients included, 30 (33.3%) developed RS. Upon consideration of interaction terms due to collinerity of variables, a statistically significant correlation was observed between pre-existing electrolyte derangements and RS occurrence (p = 0.001). Phosphate levels showed the most significant decline post-PN initiation (43%), followed by potassium (19%) and magnesium (17%), primarily within the first 24 hours. No significant associations were found between BMI, fasting duration, unintentional weight loss, or medication history and RS. However, fasting for more than five days (AOR 2.8, 95% CI 0.4-17.7) and ≥10% unintentional weight loss (AOR 1.8, 95% CI 0.4-7.7) increased the likelihood of RS.

Conclusions: RS is prevalent among adult PN patients, predominantly with mild severity. Pre-existing electrolyte abnormalities, especially in phosphate levels, were robust predictors. Larger studies are needed to better elucidate the associations between risk factors and RS in the local population.