Evaluation of refeeding hypophosphatemia frequency, risk factors, and nutritional status during stem cell transplantation in patients with hematologic malignancy.

BACKGROUND: Refeeding Hypophosphatemia (RH) occurs with feeding after an extended period of not feeding. Hematological Stem Cell Transplantation (HSCT) is one of the effective methods for hematologic malignancy. Nutritional disorders are frequently observed in hematologic malignancies due to the disease's pathology and the treatment's effect. The study aims to determine the influencing factors by determining the frequency of RH in patients treated with HSCT. METHODS: The study was conducted prospectively and randomly with 50 patients treated with HSCT for the first time. The study followed patients for 22 days, seven days before, and 14 days after. During the follow-up, data such as Scored Patient-Generated Subjective Global Assessment (PG-SGA), weight changes, nausea, vomiting, diarrhea, mucositis, infection and Graft Versus Host Disease development, need for intensive care, and 12-month mortality were recorded. RH states were evaluated during treatment. RESULTS: RH developed in 78% of patients treated with HSCT. Pre-transplantation PGSGA score, frequency of vomiting, and development of infection were higher in patients with RH (p < 0.05). The patients had a mean weight loss of 2.9% after transplantation. Pre-transplantation, 88% of patients were well-nourished (PGSGA 0-3), post-transplantation, 70% of patients were moderately undernourished (PGSGA 4-8), and 30% were severely malnourished (PGSGA ≥ 9). While total protein and albumin decreased after transplantation, CRP increased (p < 0.05). According to multivariate logistic regression analysis, infection (95% CI: 1.375-61.379, p = 0.022) and pre-transplant PGSGA (95% CI: 1.035-45.454, p = 0.046) independently affect RH development. CONCLUSIONS: RH was detected at a high rate in patients treated with HSCT. Elevated risk of malnutrition before transplantation, frequency of vomiting, and development of infection were determined as factors affecting RH development.

Enteral nutrition interruptions in critically ill patients: A prospective study on reasons, frequency and duration of interruptions of nutritional support during ICU stay.

BACKGROUND & AIMS: Enteral Nutrition (EN) may be interrupted due to various reasons in the setting of intensive care unit (ICU) care. This study aimed to investigate the reasons, frequency, and duration of EN interruptions in critically ill patients within the first 7 days of ICU stay. METHODS: A total of 122 critically ill patients (median age: 63 years, 57% were males) initiating EN within the first 72 h of ICU admission and continued EN for at least 48 h during ICU stay were included in this observational prospective study conducted at a Medical ICU. Patients were followed for hourly energy intake as well as the frequency, reason, and duration of EN interruptions, for the first seven nutrition days of ICU stay or until death/discharge from ICU. RESULTS: The median APACHE II score was 22 (IQR, 17-27). The per patient EN interruption frequency was 2.74 and the median total EN interruption duration was 960 (IQR, 105-1950) minutes. The most common reason for EN interruption was radiological procedures (91 episodes) and the longest duration of EN interruption was due to tube malfunctions (1230 min). Target energy intake were achieved on the 6th day at a maximum rate of 89.4%. Logistic regression showed that there was relationship between increased mortality and patients with ≥3 EN interruptions (OR: 6.73 (2.15-30.55), p = 0.004) after adjusting for confounding variables (age and APACHE II score). According to Kaplan Meier analysis, patients with ≥3 EN interruptions had significantly lower median survival times than patients with <3 EN interruptions (24.0 (95% CI 8.5-39.5) vs 18.0 (95% CI 13-23) days, p = 0.014). CONCLUSION: During the first week of EN support, the most common reason of EN interruptions was related to radiological procedures and the longest EN interruptions was due to feeding tube malfunctions. There was relationship between ≥3 EN interruptions and increased mortality.