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  • Küçük Resim
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    The Effects of Enteral Nutritional Support and Inflammation on Plasma Thiamine and Erythrocyte Thiamine Pyrophosphate Concentrations in the Acute Phase of Critical Illness
    (2025) Ozer, Nurhayat Tugra; Gunes Sahin, Gulsah; Sahin Ergul, Serap; Temel, Sahin; Yuksel, Recep Civan; Sungur, Murat; Thomas R. Ziegler; Gundogan, Kursat
    Objective: Plasma thiamine concentrations are decreased with inflammation, but approximately 90% of thiamine is within erythrocytes. We evaluated the effect of enteral nutritional therapy and inflammation on plasma thiamine and erythrocyte thiamine pyrophosphate (eTPP) concentrations, respectively, in critically ill patients. Materials and Methods: Blood samples were obtained from participants within the first 24-h of ICU admission, and the second sample was obtained on the discharge day in participants with ICU stay <7 days or on the 7th ICU Day in participants with ICU stay>7 days. Plasma thiamine and eTPP levels were analyzed by high-pressure liquid chromatography (HPLC). Serum C-reactive protein (CRP) concentrations were determined by turbidimetric analysis. Results: Fifty participants, 57% male, were included, and the median age was 68.0 (range: 52.5– 75.5) years. The mean plasma thiamine concentration was 13.6±5.22 nmol/L at the first time point, 15.2±5.06 nmol/L at the second time point (reference range: 8–30 nmol/L). The median eTPP value was 621 (range: 407–922) ng/gHb at the first time point and 588 (range: 338–889) ng/g Hb at the second time point (reference range: 275–675 ng/gHb). Plasma thiamine and eTPP concentrations were significantly lower in orally fed participants versus those receiving enteral tube feeding (p<0.05 for both study time points). Multiple linear regression revealed that plasma thiamine and serum CRP levels significantly predicted eTPP value (F=3.623, p=0.020, R2=0.78). Conclusion: Participants receiving enteral tube feeding had higher plasma thiamine and eTPP concentrations than those who received an oral diet alone. eTPP concentrations can be predicted by plasma thiamine coupled with serum CRP levels. Keywords: Critical illness, enteral nutrition, erythrocyte thiamine pyrophosphate, inflammation, plasma thiamine.
  • Küçük Resim
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    The Incidence and Risk Factors of Refeeding Syndromelike Hypophosphatemia in Inflammatory Bowel Disease: A Preliminary Study
    (2024) Ozer, Nurhayat Tugra; Can-Sezgin, Gulten; Sahin-Ergul, Serap; Gunes-Sahin, Gulsah; Yurci, Mustafa Alper; Guven, Kadri; Gundogan, Kursat
    Background & Aims: Refeeding syndrome (RFS) is defined by the presence of acute electrolyte disturbances, including hypophosphatemia. Underlying disease(s), malnutrition and hospitalisation are known risk factors for RFS. It can occur in patients with inflammatory bowel disease (IBD). We aimed to determine the frequency of hypophosphatemia and the relationship between hypophosphatemia, disease severity and nutritional status in hospitalized patients with IBD. Methods: This study was performed prospectively in hospitalized adult patients for the treatment of IBD in a tertiary-care hospital. Disease severity was assessed using Truelove and Witts score for ulcerative colitis (UC) and Crohn‘s Disease Activity Index for Crohn’s disease (CD). Nutritional status was determined using Subjective Global Assessment (SGA). Serum phosphate concentration was recorded for first 7 days after hospitalization, and less than 0.65 mmol/l was defined as hypophosphatemia. Results: Fifty participants (33 with UC and 17 with CD) were included in the study. The mean age of the study sample was 43.4±14.9 years, of which 64% were male. A total of 8.8% of patients with UC and 37.5% of patients with CD had severe (>moderate) disease upon study admission. Seventeen patients (34%) were malnourished. During the 7 study days, 23 participants (46%) had at least one episode of hypophosphatemia. Serum phosphate concentration was significantly and moderately correlated with serum potassium concentration in both the patients and the hypophosphatemia group on study day 3 (p<0.05). Multivariate logistic regression analysis showed that the presence of malnutrition [odds ratio (OR) = 3.64, 95% confidence interval (CI): 1.52-5.58, p=0.008), the administration of parenteral nutrition (OR=2.91, 95%Cl: 1.37-4.63, p=0.015), and severe IBD (OR=1.74, 95%CI: 1.03-3.42, p=0.020) were associated with hypophosphatemia. Conclusions: Approximately half of the participants exhibited at least one instance of hypophosphatemia during the study period. Hypophosphatemia was found to be associated with malnutrition, parenteral nutrition, and severe disease in patients with IBD requiring hospitalization.