Refeeding syndrome: Applicability of ASPEN criteria in patients with intestinal failure

Refeeding syndrome (RS) is defined as the reduction in serum levels of phosphorus, potassium, magnesium and/or thiamine, associated with the initiation of nutritional intake in patients with prolonged periods of low intake. In patients with intestinal failure (IF), risk factors for RS may be present. The aims of our study were to determine how many IF patients were at risk of RS, to determine how many of them developed RS and the accuracy of ASPEN risk criteria.

A retrospective, observational, cross-sectional study was conducted. From January 2020 to July 2024 adult patients with IF diagnosis who started parenteral nutrition were included. The variables analyzed were sex, age, percentage of weight loss, BMI, pathophysiological classification of the IF, and serum values of potassium, magnesium, and phosphorus. Risk was classified as none, significant or moderate and the development as none, mild, moderate or severe.

A total of 86 adult patients were included, 20.9 % had no risk criteria for RS, 2.3 % had moderate risk, and 76.7 % had significant risk. Fifty percent of patients with no risk criteria and 54.4 % of patients who did have risk criteria developed RS. In 63.0 % IF patients it was mild, 26.1 % moderate and severe in 10.9 %. According to the pathophysiological classification of IF, there were no differences between the groups (p > 0.9).

In this cohort of IF patients, 53.5 % developed RS. ASPEN criteria did not predict the development of 50 %. Sensitivity was 0.8 and specificity 0.23.