Frequency and Related Risk Factors of Refeeding Hypophosphatemia in Patients with Liver Cirrhosis: A Pilot Study

Background & Aims: Refeeding hypophosphataemia (RH) is associated with poor clinical outcomes and mortality rates. However, the presence of RH in patients with cirrhosis remains unknown. This study aimed to determine the relationship among the frequency of RH, nutritional status, and disease severity in patients with liver cirrhosis.Methods: This prospective study was conducted at a single-centre gastroenterology clinic. Malnutrition was identified using the Subjective Global Assessment (SGA). Disease severity was defined using the ChildTurcotte-Pugh (CTP) and the Model for End-Stage Liver Disease (MELD) scores. Hypophosphatemia was defined as a serum phosphate level of <2.0 mg/dL.Results: Twelve of 50 cirrhotic patients (24%) had RH during hospitalization. The most common RH was determined in four patients on day four during the study follow-up. The sharpest decline in serum phosphate levels was observed on day four (median: 2.3 mg/dL). The CTP score and MELD scores did not differ significantly between RH and non-RH groups ((p=0.478 and p=0.643), respectively. The rate of malnutrition according to the SGA was 56.0%. A total of 82%, 4%, 8%, and 4% of participants received regular diet and oral nutritional supplements, only enteral tube feeding, only parenteral nutrition, and combined enteral and parenteral nutrition, respectively. In the RH group, 32% of participants received only parenteral nutrition and had a higher prevalence of RH than that of patients receiving only oral or enteral tube feeding (p=0.001). The CTP score strongly and negatively correlated with serum phosphorus levels on days two (p=0.016), three (p=0.050), and seven (p=0.017) in the RH group.Conclusions: This study showed that artificial feeding (enteral or parenteral nutrition) carries a significant risk in terms of RH. Malnourished patients with liver cirrhosis who received parenteral nutrition were closely monitored for a high risk of RH. The CTP score strongly and negatively correlated with serum phosphorus levels.