Asociación entre niveles de lactato sérico y síndrome de realimentación en pacientes críticamente enfermos

• Oswaldo BOLAÑOS LADINEZ ^[3] ; Cecilia ARTEAGA-PAZMIÑO ^[1] ; Rebeca SÁNCHEZ ^[2] ; Geovanny ALVARADO VILLA ^[4] ; Evelyn FRIAS-TORAL ^[5]
  1. [1] Universidad de Guayaquil

     Universidad de Guayaquil

     Guayaquil, Ecuador

     
  2. [2] Universidad Católica de Santiago de Guayaquil

     Universidad Católica de Santiago de Guayaquil

     Guayaquil, Ecuador

     
  3. [3] Hospital Clínica San Francisco, Guayaquil, Ecuador
  4. [4] Universidad de Especialidades Espiritu Santo, Guayaquil, Ecuador
  5. [5] Universidad Espíritu Santo, Escuela de Medicina, Samborondón, Ecuador.

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• Localización: Nutrición clínica y dietética hospitalaria, ISSN 0211-6057, Vol. 45, Nº. 1, 2025, págs. 233-240
• Idioma: español
• DOI: 10.12873/451arteaga
• Títulos paralelos:
  • Association between serum lactate levels and refeeding syndrome in critical Ill patients
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• Resumen
  • español

    Objetivo: Analizar la relación entre los niveles de lactato en sangre y el desarrollo del síndrome de realimentación (SR) en pacientes críticos.

    Métodos: Este estudio de cohorte prospectivo incluyó pacientes de 18 años o más que fueron ingresados en la unidad de cuidados intensivos (UCI) del Hospital Clínica San Francisco durante al menos 48 horas entre enero y junio de 2019. El SR se definió como una disminución del 30% en el fósforo sérico dentro de las 48 horas posteriores al inicio del soporte nutricional. El lactato sérico, SOFA, APACHE II, el riesgo nutricional y el estado nutricional se midieron al ingreso a la UCI. Los análisis estadísticos se realizaron mediante la prueba t de Student, la prueba U de Mann-Whitney y la prueba de Wilcoxon.

    Resultados: Se seleccionó un total de 141 pacientes, de los cuales el 53,8% (n = 83) eran varones y el 34,8% (n = 49) desarrolló SLR. Los diagnósticos primarios fueron sepsis y condiciones neurocríticas, con una tasa de mortalidad general del 18,4%. Entre los pacientes con SR, el 85,7% (n = 41) fueron identificados como con riesgo nutricional al ingreso, y el 53,1% (n = 26) tenían desnutrición moderada. Los pacientes con RFS experimentaron estadías más prolongadas en la UCI (12 frente a 7 días, p = 0,006) y estadías hospitalarias más prolongadas (22 frente a 15 días, p = 0,007) en comparación con aquellos sin SR. Los pacientes con SR tuvieron niveles séricos de lactato significativamente más altos en comparación con aquellos sin SR (1,62 frente a 2,14 mmol/l; p = 0,002).

    Conclusiones: En el presente estudio, el nivel sérico de lactato está asociado con el desarrollo de SR en pacientes críticos.

  • English

    Aim: To analyze the relationship between blood lactate levels and the development of refeeding syndrome (RFS) in critically Ill patients.

    Methods: This prospective cohort study enrolled 141 patients aged 18 years and older who were admitted to the intensive care unit (ICU) of the Hospital Clínica San Francisco for at least 48 hours between January and June 2019. RFS was defined as a 30% decrease in serum phosphorus within 48 hours after the initiation of nutritional support. Serum lactate, SOFA, APACHE II, nutritional risk (NRS-2002), and nutritional status (SGA) were measured upon ICU admission.

    Results: 53.8% (n = 83) were male, and 34.8% (n = 49) developed RFS. The primary diagnoses were sepsis and neurocritical conditions, with an overall mortality rate of 18.4%. Among patients with RFS, 85.7% (n = 41) were identified as having a nutritional risk at admission, and 53.1% (n = 26) had moderate malnutrition. Patients with RFS experienced longer ICU stays (12 vs. 7 days, p = 0.006) and longer hospital stays (22 vs. 15 days, p = 0.007) compared to those without RFS. Patients with RFS had significantly higher serum lactate levels compared to those without RFS (1.62 vs.2.14 mmol/l; p=0.002).

    Conclusions: In the present study, serum lactate level isassociated with the development of RFS in critically ill patients.

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