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Peer-reviewedCC BY 4.0Nutrients

Refeeding Hypophosphatemia During ECMO Support: A Retrospective Cohort Study on Incidence, Predictors, and Association with Outcome

  • Patrick Haselwanter1
  • Max Oberweger1
  • Sarah Schwaiger1
  • Marlene Hintersteininger1
  • Marlene Riedl-Wewalka1
  • Mathias Maleczek2,3
  • Daniel Laxar2,3
  • Martina Hermann2,3
  • Nina Buchtele4
  • Thomas Staudinger4
  • Christian Zauner1
  • Mathias Schneeweiss-Gleixner1
4 affiliations
  1. 1Department of Medicine III, Division of Gastroenterology and Hepatology, Intensive Care Unit 13H1, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria
  2. 2Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
  3. 3Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, 1090 Vienna, Austria
  4. 4Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, 1090 Vienna, Austria
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Abstract

Background/Objectives: Refeeding syndrome (RFS) is a potentially life-threatening complication of nutritional support in critically ill patients. Its incidence and clinical relevance in patients requiring extracorporeal membrane oxygenation (ECMO) are unknown. We retrospectively investigated the incidence, characteristics and clinical relevance of RFS in COVID-19 patients receiving venovenous (vv-)ECMO support. Methods: In a secondary analysis of 101 COVID-19 patients treated with vv-ECMO at a tertiary center, RFS was defined by a decrease of more than 0.16 mmol/L in serum phosphate to a value below 0.65 mmol/L within seven days of starting medical nutrition therapy (MNT), or a pre-existing phosphate below 0.65 mmol/L. Electrolyte trajectories, nutritional delivery, predictors of RFS, and the association with ICU mortality were analyzed. Robustness was assessed across alternative published definitions. Results: RFS developed in 46 of 101 patients (45.5%), with an incidence ranging from 23.8% to 84.2% depending on the definition applied. Patients with RFS had a lower body mass index and required significantly more phosphate substitution than those without (93.5% vs. 43.6%; p < 0.001). Early energy delivery did not differ between groups and was not associated with RFS. RFS was not associated with ICU mortality (41.3% vs. 41.8%; adjusted hazard ratio 0.80, p = 0.51), a finding consistent across all definitions examined. Conclusions: In this COVID-19 vv-ECMO cohort, refeeding-associated hypophosphatemia was frequent but not associated with caloric delivery or ICU mortality under close electrolyte monitoring. These hypothesis-generating findings do not support reducing caloric intake for isolated hypophosphatemia and require prospective confirmation.

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Cite

BibTeXRIS
BibTeX
@article{haselwanter2026refeeding,
  title = {{Refeeding Hypophosphatemia During ECMO Support: A Retrospective Cohort Study on Incidence, Predictors, and Association with Outcome}},
  author = {Patrick Haselwanter and Max Oberweger and Sarah Schwaiger and Marlene Hintersteininger and Marlene Riedl-Wewalka and Mathias Maleczek and Daniel Laxar and Martina Hermann and Nina Buchtele and Thomas Staudinger and Christian Zauner and Mathias Schneeweiss-Gleixner},
  journal = {Nutrients},
  year = {2026},
  month = oct,
  doi = {10.3390/nu18213491},
  url = {https://www.mdpi.com/2072-6643/18/21/3491},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Refeeding Hypophosphatemia During ECMO Support: A Retrospective Cohort Study on Incidence, Predictors, and Association with Outcome
AU  - Patrick Haselwanter
AU  - Max Oberweger
AU  - Sarah Schwaiger
AU  - Marlene Hintersteininger
AU  - Marlene Riedl-Wewalka
AU  - Mathias Maleczek
AU  - Daniel Laxar
AU  - Martina Hermann
AU  - Nina Buchtele
AU  - Thomas Staudinger
AU  - Christian Zauner
AU  - Mathias Schneeweiss-Gleixner
PY  - 2026
DA  - 2026/10/23
JO  - Nutrients
DO  - 10.3390/nu18213491
UR  - https://www.mdpi.com/2072-6643/18/21/3491
AB  - Background/Objectives: Refeeding syndrome (RFS) is a potentially life-threatening complication of nutritional support in critically ill patients. Its incidence and clinical relevance in patients requiring extracorporeal membrane oxygenation (ECMO) are unknown. We retrospectively investigated the incidence, characteristics and clinical relevance of RFS in COVID-19 patients receiving venovenous (vv-)ECMO support. Methods: In a secondary analysis of 101 COVID-19 patients treated with vv-ECMO at a tertiary center, RFS was defined by a decrease of more than 0.16 mmol/L in serum phosphate to a value below 0.65 mmol/L within seven days of starting medical nutrition therapy (MNT), or a pre-existing phosphate below 0.65 mmol/L. Electrolyte trajectories, nutritional delivery, predictors of RFS, and the association with ICU mortality were analyzed. Robustness was assessed across alternative published definitions. Results: RFS developed in 46 of 101 patients (45.5%), with an incidence ranging from 23.8% to 84.2% depending on the definition applied. Patients with RFS had a lower body mass index and required significantly more phosphate substitution than those without (93.5% vs. 43.6%; p < 0.001). Early energy delivery did not differ between groups and was not associated with RFS. RFS was not associated with ICU mortality (41.3% vs. 41.8%; adjusted hazard ratio 0.80, p = 0.51), a finding consistent across all definitions examined. Conclusions: In this COVID-19 vv-ECMO cohort, refeeding-associated hypophosphatemia was frequent but not associated with caloric delivery or ICU mortality under close electrolyte monitoring. These hypothesis-generating findings do not support reducing caloric intake for isolated hypophosphatemia and require prospective confirmation.
SN  - 2072-6643
ER  -