Assessment of refeeding syndrome definitions and 30-day mortality in critically ill adults: A comparison study.

BACKGROUND: Patients in the intensive care unit (ICU) are at high risk for refeeding syndrome (RFS), yet there is uncertainty regarding how RFS should be operationalized in the ICU. We evaluated different definitions for RFS and tested how they associated with patient-centered outcomes in the ICU. METHODS: This was a retrospective comparison study. Patients age ≥18 years were eligible if they were newly initiated on enteral feeding while hospitalized in the ICU. Eight definitions for RFS were operationalized, including that from the American Society for Parenteral and Enteral Nutrition (ASPEN), all based on electrolyte levels from immediately before until up to 5 days after the initiation of enteral nutrition. Patients were followed for death or for ICU-free days, a measure of healthcare utilization. RESULTS: In all, 2123 patients were identified, including 406 (19.1%) who died within 30 days of ICU admission and 1717 (80.9%) who did not. Prevalence of RFS varied from 1.5% to 88% (ASPEN definition) depending on the RFS definition used. The excess risk for death associated with RFS varied from 33% to 92% across definitions. The development of RFS based on the ASPEN definition was associated with a greater decrease in ICU-free days compared with other definitions, but the relationship was not statistically significant. CONCLUSION: Eight definitions for RFS were evaluated, none of which showed strong associations with death or ICU-free days. It may be challenging to achieve a standardized definition for RFS that is based on electrolyte values and predicts mortality or ICU-free days.

Measurement of health-related quality of life in the care of patients with ESRD: isn't this the metric that matters?

An outcome can take many forms in the health care of an individual. Common measures in clinical research may include mortality, time to ESRD, or change in glomerular filtration rate. While a patient surely may share an interest with a clinician regarding these endpoints, individual life priorities expectedly vary. Outcomes of great value to a clinician (or their performance quality measures) may not be shared by their patient. While continued education and efforts in effective communication may help each party understand the reasons behind these differences, the time required to foster such dialogues remains a major hurdle for most clinicians. Through the use of contemporary computers such as smartphones, tablets, and laptops, healthcare providers can gain meaningful insight from patient-reported data such as pain, sleep, and sexual function. This review will detail how carefully constructed questionnaires with equivalent reliability as long annual surveys, such as KDQOL, can be more quickly completed by using novel technology, which can be transmitted from the patient to the clinician and back to the bedside in minutes rather than in weeks.

Hepatitis C infection and the risk of bacteremia in hemodialysis patients with tunneled vascular access catheters.

BACKGROUND: The major complication of tunneled vascular catheters in dialysis patients is infection. In preliminary work, an association was noted between hepatitis C virus (HCV) infection and bacteremia in these patients. On this basis, we theorized that HCV infection may be associated with bacteremia in dialysis patients with tunneled catheters. METHODS: We conducted a two-phase clinical study to define the association between HCV infection and bacteremia in hemodialysis patients with catheters. Phase 1 was a cross-sectional study designed to assess the association between HCV serologic status and bacteremia. Phase 2 was a prospective study that examined the relationship between HCV viral load and bacteremia. RESULTS: In Phase 1, HCV (+) patients had a significantly greater prevalence of bacteremia than HCV (-) patients (61 vs 7.7% respectively, P < 0.05). In Phase 2, the presence of detectable virus was associated with a numerical trend toward an increase in the incidence of bacteremia (40 vs 0% for patients with and without detectable virus, respectively, P = 0.09). CONCLUSION: These studies suggest that HCV infection may be associated with the development of bacteremia in hemodialysis patients with tunneled catheters.