Refeeding syndrome tied to high mortality risk in short, medium term

Refeeding syndrome contributes to a greater risk of mortality, as suggested by a nonsignificant trend toward increased death in the short term and a markedly higher mortality in the medium term, according to the results of a systematic review and meta-analysis.

“The supervision/management of the refeeding process by a nutrition specialist might be a key factor for the limitation of this mortality excess,” the investigators said.

The databases of PubMed/Medline, Embase, Cochrane Library, and Cinahl were systematically searched until September 2020. Studies that reported mortality rates in patients who developed the syndrome at renutrition compared with those who did not were included in the meta-analysis. A random-effect model was used to pool effect sizes.

Thirteen studies, including a total of 3,846 patients (mean age 64.5 years, 58 percent male), met the eligibility criteria. Pooled data revealed a nonsignificant trend toward an increased short-term mortality (≤1 month) in patients who developed refeeding syndrome (odds ratio [OR], 1.27, 95 percent confidence interval [CI], 0.93–1.72).

This trend was mostly driven by studies where renutrition was not prescribed and supervised by a nutritional support team (p=0.01 at subgroup analysis) and by studies published in previous years (p=0.04 at meta-regression).

In terms of mortality in the medium term (≤6 months), an overall statistical significance was observed toward a greater risk (OR, 1.54, 95 percent CI, 1.04–2.28).

“The refeeding syndrome has been described as a potentially life-threatening complication of renutrition,” the investigators said.