Evaluation of whole blood thiamine pyrophosphate concentrations in critically ill patients receiving chronic diuretic therapy prior to admission to Turkish intensive care units: A pragmatic, multicenter, prospective study.

Ezgi Ozyilmaz, Thomas R Ziegler, Daniel P Griffith, Murat Sungur, Recep C Yuksel, Recai Ergun, Ismail H Akbudak, Ferhan D Aydemir, Begum Ergan, Ozlem Edipoglu, Gulay Tok, Arzu Topeli, Nazif Yalcin, Kamil Gonderen, Nazire Ateş, Kursat Gundogan, Emre Aydin, Hayriye C Dal, Avsar Zerman, Ramazan Ulu, Kaniye Aydın, Zuhal Simsek, Oguzhan S Dizdar, Hamit Yildiz, Talha Ercan, Turkay Akbas, Sahin Temel, Nurhayat T Ozer, Serap S Ergul, Gulsah G Sahin

Journal: Journal of critical care 2023;77():154326

PMID: 37186999

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND/OBJECTIVES

Thiamine plays a pivotal role in energy metabolism. The aim of the study was to determine serial whole blood TPP concentrations in critically ill patients receiving chronic diuretic treatment before ICU admission and to correlate TPP levels with clinically determined serum phosphorus concentrations.

SUBJECTS/METHODS

This observational study was performed in 15 medical ICUs. Serial whole blood TPP concentrations were measured by HPLC at baseline and at days 2, 5 and 10 after ICU admission.

RESULTS

A total of 221 participants were included. Of these, 18% demonstrated low TPP concentrations upon admission to the ICU, while 26% of participants demonstrated low levels at some point during the 10-day study period. Hypophosphatemia was detected in 30% of participants at some point during the 10-day period of observation. TPP levels were significantly and positively correlated with serum phosphorus levels at each time point (P < 0.05 for all).

CONCLUSIONS

Our results show that 18% of these critically ill patients exhibited low whole blood TPP concentrations on ICU admission and 26% had low levels during the initial 10 ICU days, respectively. The modest correlation between TPP and phosphorus concentrations suggests a possible association due to a refeeding effect in ICU patients requiring chronic diuretic therapy.

Address: Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye; Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye. Electronic address: [email protected].; Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye.; Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye.; Division of Intensive Care Medicine, Department of Internal Medicine, Duzce University School of Medicine, Duzce, Turkiye.; Department of Internal Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Turkiye.; Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkiye.; Department of Nephrology, Firat Medical Faculty, Elazig, Turkiye.; Department of Intensive Care Unit, Kirsehir Ahi Evran University, Kirsehir, Turkiye.; Department of Intensive Care Unit, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkiye.; Department of Nephrology, School of Medicine, Dicle University, Diyarbakır, Turkiye.; Division of Intensive Care Medicine, Department of Internal Medicine, Cukurova University School of Medicine, Adana, Turkiye.; Clinic of Intensive Care Unit, Kütahya Evliya Çelebi Training and Research Hospital, Kütahya, Turkiye.; Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkiye.; Department of Intensive Care Unit, Health Sciences University, İzmir Dr.Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkiye.; Division of Intensive Care Medicine, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkiye.; Division of Intensive Care Medicine, Canakkale Mehmet Akif Ersoy State Hospital, Canakkale, Turkiye.; Division of Intensive Care Medicine, Department of Internal Medicine, Pamukkale University School of Medicine, Denizli, Turkiye.; Department of Chest Diseases, Selçuk University Faculty of Medicine, Konya, Turkiye.; Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye; Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye.; Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, GA, USA.; Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, GA, USA; Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.

DOI: 10.1016/j.jcrc.2023.154326

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MeSH Terms: Humans, Prospective Studies, Thiamine Pyrophosphate, Critical Illness, Intensive Care Units, Diuretics