Ryan S. Chiang, BS1, Ahmad Farooq, MBBS2, Alice Parish, MSPH3, Donna Niedzwiecki, PhD3, Matthew R. Kappus, MD2, Yuval Patel, MD2, Rodger A. Liddle, MD2, Andrew J. Muir, MD, MHS2
1Duke University School of Medicine, Durham, NC; 2Duke University Medical Center, Durham, NC; 3Duke University, Durham, NC
Introduction: Patients with alcoholic hepatitis suffer from high rates of malnutrition and are at risk for hypophosphatemia due to poor dietary intake, renal wasting, and refeeding syndrome. The aim of this study was to assess phosphate monitoring and supplementation practices in patients with alcoholic hepatitis, and to determine if phosphorous levels are associated with increased risk of morbidity and mortality in patients with alcoholic hepatitis.
Methods: A retrospective analysis was performed on a cohort identified through the use of an electronic health record query tool for an academic health system. Study population was defined as 18 years or older with hospital admission 8/1/12 to 9/30/18. Alcoholic hepatitis was defined using ICD-9/10 codes 571.1, K70.10, or K70.11. Patients also met the National Institute on Alcohol Abuse and Alcoholism criteria for alcoholic hepatitis. Patients were excluded if other etiologies of liver disease were present.
Results: 64 admissions met study criteria, and phosphate measurements occurred at least once during admission in 45/64 (70%). Patients with serum phosphorous data measured had higher serum creatinine. They also had higher Maddrey’s discriminant function and MELD scores, although not statistically significant (Table 1). Hypophosphatemia was noted in 18/45 (40%) patients at initial measurement, while 6/45 (13%) had hyperphosphatemia. Phosphate supplementation did not occur in 5/18 (28%) patients with hypophosphatemia. Of the 6 patients with hyperphosphatemia, 5 died with multi-system organ failure. There were 7 ICU admissions in the normal phosphate group, of which 6 had a reduction in phosphorous levels during the admission. Among the normal phosphorous group, phosphorous measurements were not repeated routinely during the admission. All 4 deaths in the normal phosphorous group experienced reduction in their phosphorous level during the admission; 2 did not receive any form of supplementation despite follow-up phosphorous levels below the normal range.
Discussion: Many patients with alcoholic hepatitis did not receive routine phosphorus measurement. Patients with phosphorus measurements had higher creatinine levels, suggesting that renal dysfunction prompted measurement. Among patients with normal initial phosphorous levels, all 4 deaths and 6 of 7 ICU admissions experienced evidence of refeeding syndrome. These findings reiterate the importance of phosphorus monitoring and supplementation for patients with alcoholic hepatitis.
Citation: Ryan S. Chiang, BS; Ahmad Farooq, MBBS; Alice Parish, MSPH; Donna Niedzwiecki, PhD; Matthew R. Kappus, MD; Yuval Patel, MD; Rodger A. Liddle, MD; Andrew J. Muir, MD, MHS. P2452 - HYPOPHOSPHATEMIA IN PATIENTS WITH ALCOHOLIC HEPATITIS. Program No. P2452. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.