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Feeding-associated hypophosphatemia in critically ill patients. A multicentre, observational study
Anis Chaba1, Ra'eesa Doola2, Kevin B Laupland3
1Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Intensive Care, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.
Insights
Feeding-associated hypophosphatemia affects 13% of critically ill patients, increasing 30-day mortality risk. Higher caloric intake and early nutrition initiation are linked to its development.
Area of Science:
- Critical Care Medicine
- Clinical Nutrition
- Intensive Care Unit (ICU) Management
Background:
- Feeding-associated hypophosphatemia is a recognized complication in critically ill patients, linked to adverse outcomes.
- Previous research is limited by inconsistent definitions and small sample sizes.
Purpose of the Study:
- To investigate the incidence, risk factors, and mortality association of feeding-associated hypophosphatemia in a large cohort of critically ill patients.
Main Methods:
- A multicenter retrospective cohort study involving 10,672 critically ill patients from six ICUs in Queensland, Australia.
- Feeding-associated hypophosphatemia defined as a phosphate decrease >0.16 mmol/L and nadir ≤0.80 mmol/L within 24 hours of nutrition commencement.
Main Results:
- 13% of patients developed moderate to severe feeding-associated hypophosphatemia within 24 hours of nutrition.
- Crude hospital mortality was higher in patients with moderate to severe hypophosphatemia (18% vs. 14%).
- Independent risk factors included higher caloric quantity, early nutrition initiation (within 48 hours), and insulin use.
Conclusions:
- Moderate to severe feeding-associated hypophosphatemia is independently associated with increased 30-day hospital mortality in critically ill patients.
- Caloric dose and early nutrition initiation are significant factors in the development of this condition.
Background:
Feeding-associated hypophosphataemia in critically ill patients is a well-recognised phenomenon that has been associated with adverse outcomes. However, the research has been limited by various definitions and small sample sizes.
Methods:
A multicentre retrospective cohort study of critically ill patients from six intensive care units in Queensland, Australia. Feeding-associated hypophosphataemia was defined as a decrease of >0.16 mmol.L-1 and a phosphate nadir of 0.80 ≤ mmol.L-1 within 24 h of nutrition commencement.
Results:
A total of 10,672 patients, with a mean age of 56 ± 17 years and a mean Acute Physiology and Chronic Health Evaluation III score of 63 ± 27, were included. On the day of nutrition commencement, 7801 (73 %) patients were invasively ventilated, and 7053 (66 %) were on vasopressor support. Within 24 h of nutrition, 1298 (13 %) developed moderate to severe feeding-associated hypophosphataemia. Crude hospital mortality was higher in the moderate/severe feeding-associated hypophosphatemia group compared to the control group (18 % vs. 14 %, p < 0.001). Caloric quantity (aOR = 1.06; 95 %CI [1.02, 1.10]), feeding commenced within 48 h of admission (aOR = 1.56; 95 %CI [1.28, 1.91]) and receiving insulin on the day of feeding start (aOR = 1.22; 95 %CI [1.07, 1.40]) were independently associated with developing feeding-associated hypophosphataemia. After adjustment for confounders, moderate-severe feeding-associated hypophosphataemia was independently associated with an increased risk of 30-day hospital mortality (HR = 1.30; 95 %CI [1.08 to 1.56]).
Conclusion:
In a large group of critically ill patients, almost one in seven patients experienced moderate to severe hypophosphatemia after starting to consume calories. The dose of caloric intake and early nutrition initiation were linked to its development. Additionally, moderate to severe hypophosphatemia was independently associated with a higher risk of 30-day hospital mortality.
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