Predicting Recurrent Deficiency and Suboptimal Monitoring of Thiamin Deficiency in Patients with Metabolic and Bariatric Surgery

Overview

Journal Nutrients

Date 2024 Jul 27

PMID 39064668

Authors

Julie M Parrott

Austen J Parrott

J Scott Parrott

Noel N Williams

Kristoffel R Dumon

Affiliations

Soon will be listed here.

Abstract

Introduction: Vitamin B1 (thiamine) deficiency (TD) after metabolic and bariatric surgery (MBS) is often insidious and, if unrecognized, can lead to irreversible damage or death. As TD symptoms are vague and overlap with other disorders, we aim to identify predictors of recurrent TD and failure to collect B1 labs.

Methods: We analyzed a large sample of data from patients with MBS ( = 878) to identify potential predictors of TD risk. We modeled recurrent TD and failure to collect B1 labs using classical statistical and machine learning (ML) techniques.

Results: We identified clusters of labs associated with increased risk of recurrent TD: micronutrient deficiencies, abnormal blood indices, malnutrition, and fluctuating electrolyte levels (aIRR range: 1.62-4.68). Additionally, demographic variables associated with lower socioeconomic status were predictive of recurrent TD. ML models predicting characteristics associated with failure to collect B1 labs achieved 75-81% accuracy, indicating that clinicians may fail to match symptoms with the underlying condition.

Conclusions: Our analysis suggests that both clinical and social factors can increase the risk of life-threatening TD episodes in some MBS patients. Identifying these indicators can help with diagnosis and treatment.

References

Oudman E, Wijnia J, van Dam M, Biter L, Postma A . Preventing Wernicke Encephalopathy After Bariatric Surgery. Obes Surg. 2018; 28(7):2060-2068. PMC: 6018594. DOI: 10.1007/s11695-018-3262-4. View

Calderon-Ospina C, Nava-Mesa M . B Vitamins in the nervous system: Current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin. CNS Neurosci Ther. 2019; 26(1):5-13. PMC: 6930825. DOI: 10.1111/cns.13207. View

Sechi G, Serra A . Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007; 6(5):442-55. DOI: 10.1016/S1474-4422(07)70104-7. View

Benotti P, Wood G, Dove J, Kaberi-Otarod J, Still C, Gerhard G . Iron deficiency is highly prevalent among candidates for metabolic surgery and may affect perioperative outcomes. Surg Obes Relat Dis. 2021; 17(10):1692-1699. DOI: 10.1016/j.soard.2021.05.034. View

Cappellini M, Comin-Colet J, de Francisco A, Dignass A, Doehner W, Lam C . Iron deficiency across chronic inflammatory conditions: International expert opinion on definition, diagnosis, and management. Am J Hematol. 2017; 92(10):1068-1078. PMC: 5599965. DOI: 10.1002/ajh.24820. View

Ratnasingham K, Knight J, Liu M, Karatsai E, Humadi S, Irukulla S . NHS litigation in bariatric surgery over a ten year period. Int J Surg. 2017; 40:14-16. DOI: 10.1016/j.ijsu.2017.02.013. View

Tzoumas L, Samara E, Tzoumas K, Tzimas P, Vlachos K, Papadopoulos G . Medico-Legal Analysis of General Surgery Cases in Greece: A 48 Year Study. Cureus. 2021; 13(7):e16205. PMC: 8340351. DOI: 10.7759/cureus.16205. View

Green G, Diggle P . On the operational characteristics of the Benjamini and Hochberg False Discovery Rate procedure. Stat Appl Genet Mol Biol. 2007; 6:Article27. DOI: 10.2202/1544-6115.1302. View

Berger M, Shenkin A, Schweinlin A, Amrein K, Augsburger M, Biesalski H . ESPEN micronutrient guideline. Clin Nutr. 2022; 41(6):1357-1424. DOI: 10.1016/j.clnu.2022.02.015. View

10.

Rodriguez J, Perez A, Lozano J . Sensitivity analysis of kappa-fold cross validation in prediction error estimation. IEEE Trans Pattern Anal Mach Intell. 2010; 32(3):569-75. DOI: 10.1109/TPAMI.2009.187. View

11.

Manigrasso M, Velotti N, De Palma G, Musella M . Comment on Wijnia, J.W. A Clinician's View of Wernicke-Korsakoff Syndrome. 2022, , 6755. J Clin Med. 2023; 12(19). PMC: 10573923. DOI: 10.3390/jcm12196393. View

12.

Timsit G, Johanet H . Medico-legal claims in bariatric surgery in France between 2010 and 2015. J Visc Surg. 2019; 156 Suppl 1:S51-S55. DOI: 10.1016/j.jviscsurg.2019.04.004. View

13.

Johnson L, Asigbee F, Crowell R, Negrini A . Pre-surgical, surgical and post-surgical experiences of weight loss surgery patients: a closer look at social determinants of health. Clin Obes. 2018; 8(4):265-274. PMC: 6039235. DOI: 10.1111/cob.12251. View

14.

Mechanick J, Apovian C, Brethauer S, Garvey W, Joffe A, Kim J . Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of.... Obesity (Silver Spring). 2020; 28(4):O1-O58. DOI: 10.1002/oby.22719. View

15.

Donnino M, Vega J, Miller J, Walsh M . Myths and misconceptions of Wernicke's encephalopathy: what every emergency physician should know. Ann Emerg Med. 2007; 50(6):715-21. DOI: 10.1016/j.annemergmed.2007.02.007. View

16.

Caine D, Halliday G, Kril J, Harper C . Operational criteria for the classification of chronic alcoholics: identification of Wernicke's encephalopathy. J Neurol Neurosurg Psychiatry. 1997; 62(1):51-60. PMC: 486695. DOI: 10.1136/jnnp.62.1.51. View

17.

Morton J, Khoury H, Brethauer S, Baker J, Sweet W, Mattar S . First report from the American Society of Metabolic and Bariatric Surgery closed-claims registry: prevalence, causes, and lessons learned from bariatric surgery medical malpractice claims. Surg Obes Relat Dis. 2022; 18(7):943-947. DOI: 10.1016/j.soard.2022.04.004. View

18.

Smith T, Johnson C, Koshy R, Hess S, Qureshi U, Mynak M . Thiamine deficiency disorders: a clinical perspective. Ann N Y Acad Sci. 2020; 1498(1):9-28. PMC: 8451766. DOI: 10.1111/nyas.14536. View

19.

Camaschella C, Girelli D . The changing landscape of iron deficiency. Mol Aspects Med. 2020; 75:100861. DOI: 10.1016/j.mam.2020.100861. View

20.

Tang L, AlSulaim H, Canner J, Prokopowicz G, Steele K . Prevalence and predictors of postoperative thiamine deficiency after vertical sleeve gastrectomy. Surg Obes Relat Dis. 2018; 14(7):943-950. DOI: 10.1016/j.soard.2018.03.024. View