Predicting refeeding hypophosphataemia: insulin growth factor 1 (IGF-1) as a diagnostic biochemical marker for clinical practice

Atul Goyale; Sarah L. Ashley; David R. Taylor; Manal O. Elnenaei; Jamshid Alaghband-Zadeh; Roy Sherwood; Carel W. le Roux; Royce Vincent

doi:10.1177/0004563214523739

Predicting refeeding hypophosphataemia: insulin growth factor 1 (IGF-1) as a diagnostic biochemical marker for clinical practice

Atul Goyale^*, Sarah L. Ashley, David R. Taylor, Manal O. Elnenaei, Jamshid Alaghband-Zadeh, Roy Sherwood, Carel W. le Roux, Royce Vincent

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

30 Citations (Scopus)

Abstract

Background: Refeeding syndrome (RS) is a potentially fatal condition that can occur following the re-introduction of nutrition after a period of starvation. Hypophosphataemia following the reintroduction of nutrition is often the only reliable biochemical marker of RS. Refeeding index (RI) generated from baseline insulin-like growth factor-1 (IGF-1) and leptin has been proposed as a useful biochemical marker for the identification of patients at risk of developing refeeding hypophosphataemia (RH).

Methods: A prospective study included 52 patients referred for parenteral nutrition (PN). The sensitivity and specificity of IGF-1 measured using a sensitive assay was compared to the RI in predicting the development of RH (a 30% drop in PO4 during the first 36-h of PN administration). Leptin and IGF-1 were analysed on baseline samples using a quantitative enzyme-linked immunoassay. Daily blood samples were collected from all patients for routine biochemistry for the full duration of PN administration.

Results: High sensitivity IGF-1 measurement alone was comparable with the RI, using receiver-operating characteristic (ROC) curve analysis, with areas under the curve being 0.79 and 0.80, respectively, and superior to leptin alone (0.72) for predicting 30% drop in PO4. The cut-off value for IGF-1 that gave best sensitivity (91% [95% CI 75-98%]) and specificity (65% [95% CI 41-85%]) was 63.7 mu g/L, with a likelihood ratio of 2.59.

Conclusion: Baseline IGF-1 is an objective, sensitive and specific biochemical marker in identifying patients who are at high risk of developing RH prior to PN administration and therefore may have a role in clinical practice.

Original language	English
Pages (from-to)	82-87
Number of pages	6
Journal	Annals of Clinical Biochemistry
Volume	52
Issue number	1
DOIs	https://doi.org/10.1177/0004563214523739
Publication status	Published - Jan 2015

Keywords

Refeeding syndrome
insulin-like growth factor-1
leptin
refeeding hypophosphataemia
CRITICALLY-ILL PATIENTS

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@article{6c5e7bfd886e4f448e608e5fd821afb5,

title = "Predicting refeeding hypophosphataemia: insulin growth factor 1 (IGF-1) as a diagnostic biochemical marker for clinical practice",

abstract = "Background: Refeeding syndrome (RS) is a potentially fatal condition that can occur following the re-introduction of nutrition after a period of starvation. Hypophosphataemia following the reintroduction of nutrition is often the only reliable biochemical marker of RS. Refeeding index (RI) generated from baseline insulin-like growth factor-1 (IGF-1) and leptin has been proposed as a useful biochemical marker for the identification of patients at risk of developing refeeding hypophosphataemia (RH).Methods: A prospective study included 52 patients referred for parenteral nutrition (PN). The sensitivity and specificity of IGF-1 measured using a sensitive assay was compared to the RI in predicting the development of RH (a 30% drop in PO4 during the first 36-h of PN administration). Leptin and IGF-1 were analysed on baseline samples using a quantitative enzyme-linked immunoassay. Daily blood samples were collected from all patients for routine biochemistry for the full duration of PN administration.Results: High sensitivity IGF-1 measurement alone was comparable with the RI, using receiver-operating characteristic (ROC) curve analysis, with areas under the curve being 0.79 and 0.80, respectively, and superior to leptin alone (0.72) for predicting 30% drop in PO4. The cut-off value for IGF-1 that gave best sensitivity (91% [95% CI 75-98%]) and specificity (65% [95% CI 41-85%]) was 63.7 mu g/L, with a likelihood ratio of 2.59.Conclusion: Baseline IGF-1 is an objective, sensitive and specific biochemical marker in identifying patients who are at high risk of developing RH prior to PN administration and therefore may have a role in clinical practice.",

keywords = "Refeeding syndrome, insulin-like growth factor-1, leptin, refeeding hypophosphataemia, CRITICALLY-ILL PATIENTS",

author = "Atul Goyale and Ashley, {Sarah L.} and Taylor, {David R.} and Elnenaei, {Manal O.} and Jamshid Alaghband-Zadeh and Roy Sherwood and {le Roux}, {Carel W.} and Royce Vincent",

year = "2015",

month = jan,

doi = "10.1177/0004563214523739",

language = "English",

volume = "52",

pages = "82--87",

journal = "Annals of Clinical Biochemistry",

issn = "0004-5632",

publisher = "SAGE Publications Ltd",

number = "1",

}

TY - JOUR

T1 - Predicting refeeding hypophosphataemia

T2 - insulin growth factor 1 (IGF-1) as a diagnostic biochemical marker for clinical practice

AU - Goyale, Atul

AU - Ashley, Sarah L.

AU - Taylor, David R.

AU - Elnenaei, Manal O.

AU - Alaghband-Zadeh, Jamshid

AU - Sherwood, Roy

AU - le Roux, Carel W.

AU - Vincent, Royce

PY - 2015/1

Y1 - 2015/1

N2 - Background: Refeeding syndrome (RS) is a potentially fatal condition that can occur following the re-introduction of nutrition after a period of starvation. Hypophosphataemia following the reintroduction of nutrition is often the only reliable biochemical marker of RS. Refeeding index (RI) generated from baseline insulin-like growth factor-1 (IGF-1) and leptin has been proposed as a useful biochemical marker for the identification of patients at risk of developing refeeding hypophosphataemia (RH).Methods: A prospective study included 52 patients referred for parenteral nutrition (PN). The sensitivity and specificity of IGF-1 measured using a sensitive assay was compared to the RI in predicting the development of RH (a 30% drop in PO4 during the first 36-h of PN administration). Leptin and IGF-1 were analysed on baseline samples using a quantitative enzyme-linked immunoassay. Daily blood samples were collected from all patients for routine biochemistry for the full duration of PN administration.Results: High sensitivity IGF-1 measurement alone was comparable with the RI, using receiver-operating characteristic (ROC) curve analysis, with areas under the curve being 0.79 and 0.80, respectively, and superior to leptin alone (0.72) for predicting 30% drop in PO4. The cut-off value for IGF-1 that gave best sensitivity (91% [95% CI 75-98%]) and specificity (65% [95% CI 41-85%]) was 63.7 mu g/L, with a likelihood ratio of 2.59.Conclusion: Baseline IGF-1 is an objective, sensitive and specific biochemical marker in identifying patients who are at high risk of developing RH prior to PN administration and therefore may have a role in clinical practice.

AB - Background: Refeeding syndrome (RS) is a potentially fatal condition that can occur following the re-introduction of nutrition after a period of starvation. Hypophosphataemia following the reintroduction of nutrition is often the only reliable biochemical marker of RS. Refeeding index (RI) generated from baseline insulin-like growth factor-1 (IGF-1) and leptin has been proposed as a useful biochemical marker for the identification of patients at risk of developing refeeding hypophosphataemia (RH).Methods: A prospective study included 52 patients referred for parenteral nutrition (PN). The sensitivity and specificity of IGF-1 measured using a sensitive assay was compared to the RI in predicting the development of RH (a 30% drop in PO4 during the first 36-h of PN administration). Leptin and IGF-1 were analysed on baseline samples using a quantitative enzyme-linked immunoassay. Daily blood samples were collected from all patients for routine biochemistry for the full duration of PN administration.Results: High sensitivity IGF-1 measurement alone was comparable with the RI, using receiver-operating characteristic (ROC) curve analysis, with areas under the curve being 0.79 and 0.80, respectively, and superior to leptin alone (0.72) for predicting 30% drop in PO4. The cut-off value for IGF-1 that gave best sensitivity (91% [95% CI 75-98%]) and specificity (65% [95% CI 41-85%]) was 63.7 mu g/L, with a likelihood ratio of 2.59.Conclusion: Baseline IGF-1 is an objective, sensitive and specific biochemical marker in identifying patients who are at high risk of developing RH prior to PN administration and therefore may have a role in clinical practice.

KW - Refeeding syndrome

KW - insulin-like growth factor-1

KW - leptin

KW - refeeding hypophosphataemia

KW - CRITICALLY-ILL PATIENTS

U2 - 10.1177/0004563214523739

DO - 10.1177/0004563214523739

M3 - Article

SN - 0004-5632

VL - 52

SP - 82

EP - 87

JO - Annals of Clinical Biochemistry

JF - Annals of Clinical Biochemistry

IS - 1

ER -

Predicting refeeding hypophosphataemia: insulin growth factor 1 (IGF-1) as a diagnostic biochemical marker for clinical practice

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