# Meta‐Analysis of Refeeding Syndrome in Predicting the Risk of Occurrence in Critically Ill Patients

## TL;DR

This study identifies risk factors for refeeding syndrome in ICU patients, helping to predict who is most at risk when starting nutritional support.

## Contribution

The study provides a meta-analysis of risk factors for refeeding syndrome in critically ill patients receiving nutritional support.

## Key findings

- Serum phosphorus and albumin levels are significant predictors of refeeding syndrome.
- Initiating feeding within 48 hours of ICU admission increases the risk of refeeding syndrome.
- A history of diabetes is associated with a higher risk of developing refeeding syndrome.

## Abstract

Patients admitted to the intensive care unit (ICU) have a high risk of refeeding syndrome (RFS). Identifying RFS in its early stages is often challenging, making preventive interventions for high‐risk patients difficult. The aim of this review is to identify risk factors for RFS in ICU patients receiving nutritional support.

We systematically searched CNKI, Wanfang, VIP, PubMed, Cochrane, Embase, and Web of Science up to November 2024 for cohort/case–control studies assessing RFS risk factors in adults (≥ 18 years). Risk of bias was evaluated using Risk Of Bias In Non‐randomized Studies of Interventions (ROBINS‐I). Data were analyzed using RevMan 5.4.

Eighteen articles were included, comprising 3360 cases. Baseline serum phosphate [weighted mean difference (WMD) = −0.10, 95% confidence interval (95% CI) (−0.19∼−0.01)], magnesium [WMD = −0.01, 95% CI (−0.04–0.02)], potassium [WMD = −0.02, 95% CI (−0.06–0.02)], albumin [WMD = −2.08, 95% CI (−3.81, −0.36)], prealbumin [(WMD = −15.37, 95% CI (−33.00–2.27)], daily protein intake [WMD = 0.23, 95% CI (0.17–0.28)], APACHE II score [WMD = 2.65, 95% CI (1.22–4.08)], NRS2002 score [WMD = 0.68, 95% CI (−0.41–1.77)], SOFA score [WMD = 1.87, 95% CI (1.50–2.25)], age [WMD = 8.67, 95% CI (7.14–10.19)], daily calorie intake [odds ratio (OR) = 0.35, 95% CI (0.25, 0.49)], feeding within 48 h of ICU admission [OR = 1.98, 95% CI (1.56, 2.51)], and a history of diabetes [OR = 3.84, 95% CI (1.17, 12.59)] are the risk factors for meta‐analysis in this article. The ROBINS‐I assessment showed moderate‐to‐severe bias (10 severe, 8 moderate).

The meta‐analysis identified serum levels of phosphorus and albumin; daily protein and calorie intake; APACHE II score; SOFA score; age; initiation of feeding within 48 h of ICU admission; and a history of diabetes as significant predictors of RFS development in critically ill patients. Serum levels of magnesium, potassium, and prealbumin and the NRS2002 score were not associated with RFS in these patients.