Refeeding syndrome influences outcome of anorexia nervosa patients in intensive care unit: an observational study
Open accessAbstract
Introduction: Data on the epidemiology and management of anorexia nervosa (AN) in the intensive care unit (ICU) are scarce. The aim of this study was to evaluate the prevalence and associated morbidity and mortality of AN in French ICUs. Methods: We randomly selected 30 ICUs throughout France. Thereafter, we retrospectively analyzed all patients with AN admitted to any of these 30 ICUs between May 2006 and May 2008. We considered demographic data, diagnosis at admission and complications occurring during the stay, focusing on refeeding syndrome and management of refeeding. Results: Eleven of the 30 ICUs participated in the retrospective study, featuring 68 patients, including 62 women. Average body mass index at the admission was 12 ± 3 kg/m2. Twenty one were mechanically ventilated, mainly for neurological reasons. The reported average calorie intake was 22.3 ± 13 kcal/kg/24 h. Major diagnoses at admission were metabolic problems, refeeding survey and voluntary drug intoxication and infection. The most common complications were metabolic, hematological, hepatic, and infectious events, of which 10% occurred during refeeding. Seven patients developed refeeding syndrome. At day one, the average calorie intake was higher for patients who developed refeeding syndrome (23.2 ± 5 Kcal/kg/j; n = 7) versus patients without refeeding syndrome (14.1 ± 3 Kcal/kg/j; n = 61) P = 0.02. Seven patients died, two from acute respiratory distress syndrome and five from multiorgan-failure associated with major hydroelectrolytic problems. Conclusions: The frequency of AN in ICU patients is very low and the crude mortality in this group is about 10%. Prevention and early-detection of refeeding syndrome is the key point.
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Starvation itself is the most reliable predictor of refeeding syndrome.
“Starvation itself is the most reliable predictor [115].”
From ESPEN guideline on hospital nutrition (2021) · cites this paper as [115]
The Discussion (page unavailable) identifies anorexia nervosa and malnutrition as risk factors for refeeding syndrome, which supports the link to starvation. It does not rank starvation as the most reliable predictor; it separately reports that a prospective study found serum prealbumin to be the only predictive biomarker. (LLM, conf=0.84)
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Hambleton, A., Pepin, G., Le, A., Maloney, D., National Eating Disorder Research Consortium, Aouad, P., Barakat, S., Boakes, R., Brennan, L., Bryant, E., et al. (2022) · Journal of Eating Disorders · doi:10.1186/s40337-022-00654-2 · Cited by 377 · see citing works
ESPEN guideline on hospital nutrition
Thibault, R., Abbasoglu, O., Ioannou, E., Meija, L., Ottens-Oussoren, K., Pichard, C., Rothenberg, E., Rubin, D., Siljamäki-Ojansuu, U., Vaillant, M.-F., et al. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.09.039 · Cited by 259 · see citing works
Olthof, L. E., Koekkoek, W. A. C. K., van Setten, C., Kars, J. C. N., van Blokland, D., & van Zanten, A. R. H. (2018) · Clinical Nutrition · doi:10.1016/j.clnu.2017.08.001 · Cited by 156 · see citing works
- Authors
- Vignaud, M., Constantin, J.-M., Ruivard, M., Villemeyre-Plane, M., Futier, E., Bazin, J.-E., Annane, D., & AZUREA group (AnorexieRea Study Group)
- Affiliations
- Centre Hospitalier Universitaire de Clermont-Ferrand (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Corresponding author
- Constantin, Jean-Michel
- Venue
- Critical Care
- Published
- 2010-09-28
- Volume
- 14
- Issue
- 5
- Pages
- R172-R172
- ISSN
- 1364-8535 (ISSN-L)
- PMC
- PMC3219274
- OpenAlex
- W2156510098
- Cited by
- 110
- References
- 1
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 6 · 2023: 4 · 2022: 7 · 2021: 5 · 2020: 13 · 2019: 4 · 2018: 8 · 2017: 10 · 2016: 7 · 2015: 10 · 2014: 9 · 2013: 7 · 2012: 6
- FWCI
- 5.99
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Critical Care (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- Funders
- Centre Hospitalier Universitaire de Nice
- Assistance publique-Hôpitaux de Paris
- Centre Hospitalier Universitaire de Nîmes
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- anorexia nervosa, refeeding syndrome, intensive care unit, critically ill patients, mortality, mechanical ventilation, energy intake, multiple organ failure, acute respiratory distress syndrome
- MeSH terms
- Adult, Anorexia Nervosa, Female, Humans, Intensive Care Units, Male, Retrospective Studies, Treatment Outcome, Refeeding Syndrome, Young Adult
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