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Refeeding Syndrome as a Possible Cause of Very Early Mortality in Acute Pancreatitis.
Gut Liver. 2019 Feb 27;:
Authors: Jeon TJ, Lee KJ, Woo HS, Kim EJ, Kim YS, Park JY, Cho JH
Abstract
Background/Aims: : The incidence and cause of early mortality in acute pancreatitis (AP) arenot fully understood. Refeeding syndrome (RFS) is a fatal clinical complication that can occuras a result of fluid and electrolyte shifts during early nutritional rehabilitation for malnourishedpatients. This study was conducted to determine the clinical implications of RFS in patientswith AP.
Methods: : Between 2006 and 2016, AP patients with very early mortality wereretrospectively enrolled from three university hospitals.
Results: : Among 3,206 patients withAP, 44 (1.4%) died within 3 days after diagnosis. The median age was 52.5 years (range, 27 to92 years), male-to-female ratio was 3:1, and median duration from admission to death was 33hours (range, 5 to 72 hours). The etiology of AP was alcohol abuse in 32 patients, gallstones infive patients, hypertriglyceridemia in two patients, and various causes in the remaining fivepatients. Ranson score, BISAP, and APACHE-II were valuable for predicting very earlymortality (median, [range]; 5 [1 to 8], 3 [0 to 5], and 19 [4 to 45], respectively); however, CTSIwas not (2 [0 to 10]). RFS was diagnosed in nine patients who died of septic shock (n=5),cardiogenic shock (n=2), or cardiac arrhythmia (n=2). In addition, patients with RFS hadsignificant hypophosphatemia compared to non-RFS patients (2.6 mg/dL [1.3 to 5.1] vs 5.8mg/dL [0.8 to 15.5]; p=0.001). The early AP-related mortality rate within 3 days wasapproximately 1.4%, and RFS occurred in 20.5% of these patients following sudden nutritionalsupport.
Conclusions: : The findings of current study emphasize that clinicians should be awareof the possibility of RFS in malnourished AP patients with electrolyte imbalances.
PMID: 30970437 [PubMed - as supplied by publisher]