A non-linear positive relationship between serum phosphate and clinical outcomes in sepsis

Guo, Cuirong; Su, Yingjie; He, Lin; Zeng, Zhao; Ding, Ning

doi:10.1016/j.heliyon.2022.e12619

Cited by 4 publications

(11 citation statements)

References 34 publications

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“…Zhong et al observed a U-shaped association between serum phosphate levels and all-cause mortality in a retrospective cohort study of 2944 patients with acute ischemic stroke 13 . Accumulating evidence has indicated that higher serum phosphate levels are significantly associated with worse outcomes in patients with sepsis 16 , 38 , 39 . However, no relevant studies have focused on the relationship between serum phosphate levels and the prognosis of septic shock.…”

Section: Discussionmentioning

confidence: 99%

“…Several mechanisms may explain these observations. Hyperphosphatemia causes endothelial dysfunction and vascular calcification, resulting in impaired microcirculatory blood flow and organ dysfunction 39 , 47 . Accumulating evidences demonstrates that hyperphosphatemia contributes to inflammation, oxidative stress, and mitochondrial dysfunction, all of which are involved in the pathogenesis of septic shock 16 , 35 .…”

Section: Discussionmentioning

confidence: 99%

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Association of serum phosphate and changes in serum phosphate with 28-day mortality in septic shock from MIMIC-IV database

Nan,

Huang,

Wan

et al. 2023

Sci Rep

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This study aimed to investigate the relationship between serum phosphate levels, changes in serum phosphate levels, and 28-day mortality in patients with septic shock. In this retrospective study, data were collected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database between 2008 and 2019. Patients were divided into three groups according to the tertiles of serum phosphate levels. Kaplan–Meier curves and log-rank test analyses were used for survival analysis. Multivariate logistic regression, and restricted cubic spline (RCS) curve were used to explore the association between serum phosphate, delta serum phosphate levels and 28-day mortality. In total, 3296 patients with septic shock were included in the study, and the 28-day mortality was 30.0%. Serum phosphate levels were significantly higher in the non-survivor group than in the survivor group. The Kaplan–Meier curves showed significant differences among the three groups. Multivariate logistic regression analysis and the RCS curve showed that serum phosphate levels were independently and positively associated with the 28-day mortality of septic shock. Non-survivors had higher delta serum phosphate levels than survivors. Survival analysis showed that patients with higher delta serum phosphate levels had higher 28-day mortality. A non-linear relationship was detected between delta serum phosphate and 28-day mortality with a point of inflection at − 0.3 mg/dL. Serum phosphate levels were positively and independently associated with 28-day mortality in septic shock. Delta serum phosphate level was a high-risk factor for patients with septic shock.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of serum phosphate and changes in serum phosphate with 28-day mortality in septic shock from MIMIC-IV database

Nan,

Huang,

Wan

et al. 2023

Sci Rep

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“…After a full-text review of the 151 studies, 141 were excluded. Finally, 10 studies ( Jung et al, 2016 ; Al Meshari et al, 2019 ; Jang et al, 2020 ; Miller et al, 2020 ; Wang et al, 2020 , 2021 ; Cao et al, 2021 ; Guo et al, 2022 ; Li, Shen & Han, 2022 ; Xu et al, 2023 ) were included in the meta-analysis ( Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Six studies reported serum phosphate levels as a continuous variable ( Jung et al, 2016 ; Wang et al, 2020 ; Cao et al, 2021 ; Guo et al, 2022 ; Li, Shen & Han, 2022 ; Xu et al, 2023 ). Except for the study by Wang et al (2020) , which did not provide the number of deaths, a total of 24,724 patients with 6,222 deaths (25.2%) were involved in the other five studies.…”

Section: Resultsmentioning

confidence: 99%

Prognostic value of serum phosphate levels in sepsis: a systematic review and meta-analysis

Wei,

Li,

Zhang

et al. 2023

PeerJ

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Background There remain controversies over the conclusion of different serum phosphate levels as prognostic predictors of sepsis patients. As such, this study investigated the association between different serum phosphate and the prognosis of sepsis. Methods Data from PubMed, Embase, Cochrane Library, and Web of Science were systematically retrieved from the inception of databases to June 1, 2023 and independently screened and extracted by two authors. Binary variables in the study were estimated as relative risk ratio (RR) and 95% confidence interval (CI), and continuous variables were estimated as mean and standard deviation. The Newcastle-Ottawa Scale (NOS) was employed to evaluate the quality of the included studies, and subgroup analysis and sensitivity analysis were performed for all outcomes to explore the sources of heterogeneity. Results Ten studies were included in this study including 38,320 patients with sepsis or septic shock. Against normal serum phosphate levels, a high serum phosphate level was associated with an elevated all-cause mortality risk (RR = 1.46; 95% CI [1.22–1.74]; P = 0.000) and prolonged Intensive Care Unit (ICU) length of stay (LOS) (WMD = 0.63; 95% CI [0.27–0.98]; P = 0.001). However, there was no significant difference in the in-hospital LOS (WMD = 0.22; 95% CI [−0.61–1.05]; P = 0.609). A low serum phosphate level was not significantly associated with the all-cause mortality risk (RR = 0.97; 95% CI [0.86–1.09]; P = 0.588), ICU LOS (WMD = −0.23; 95% CI [−0.75–0.29]; P = 0.394) and in-hospital LOS (WMD = −0.62; 95% CI [−1.72–0.49]; P = 0.274). Conclusion Sepsis patients with high serum phosphate levels before therapeutic interventions were associated with a significant increase in the all-cause mortality risk, prolonged ICU LOS, and no significant difference in in-hospital LOS. Sepsis patients with low serum phosphate levels before interventions may have a reduced risk of all-cause mortality, shorter ICU LOS, and in-hospital LOS, but the results were not statistically significant.

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“…The primary research index was the delta serum phosphate during the first three days of sepsis, defined as the absolute difference between the maximum and minimum serum phosphate during the first three days. Patients with sepsis were divided into four groups according to the quartile of the delta serum phosphate: 0-1.3, 1.4-2.0, 2.1–3.1, and ≥ 3.2 mg/dl [ 16 ]. To further evaluate the effect of the direction of the delta serum phosphate on the prognosis of patients with sepsis, the time relationship between the maximum and the minimum value of serum phosphate was evaluated.…”

Section: Methodsmentioning

confidence: 99%

Effect of early serum phosphate disorder on in-hospital and 28-day mortality in sepsis patients: a retrospective study based on MIMIC-IV database

Luo,

Peng,

Tang

et al. 2024

BMC Med Inform Decis Mak

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Background This study aims to assess the influence of early serum phosphate fluctuation on the short-term prognosis of sepsis patients. Methods This retrospective study used the Medical Information Mart for Intensive Care IV database to analyze serum phosphate levels in sepsis patients within 3 days of ICU admission. According to the absolute value of delta serum phosphate (the maximum value minus the minimum value of serum phosphorus measured within three days), the patients were divided into four groups, 0–1.3, 1.4–2.0, 2.1–3.1, and ≥ 3.2 mg/dl. Meanwhile, the direction of delta serum phosphate was compared. With the serum phosphate change group of 0–1.3 mg/dl as the reference group, the relationship between delta serum phosphate and in-hospital mortality and 28-day mortality was analyzed by multivariate Logistics regression analysis. Results The study involved 1375 sepsis patients. Serum phosphate changes (0–1.3, 1.4–2.0, 2.1–3.1, and ≥ 3.2 mg/dl) correlated with in-hospital and 28-day mortality variations (p = 0.005, p = 0.008). Much higher serum phosphate fluctuation elevated in-hospital and 28-day mortality. Compared to the 0–1.3 mg/dl change group, adjusted odds ratios (OR) in other groups for in-hospital mortality were 1.25 (0.86–1.81), 1.28 (0.88–1.86), and 1.63 (1.10–2.43), and for 28-day mortality were 1.21 (0.86–1.72), 1.10 (0.77–1.57), and 1.49 (1.03–2.19). Under the trend of increasing serum phosphate, the ORs of in-hospital mortality and 28-day mortality in ≥ 3.2 mg/dl group were 2.52 and 2.01, respectively. Conclusion In conclude, the delta serum phosphate ≥ 3.2 mg/dl was associated with in-hospital mortality and 28-day mortality in patients with sepsis.

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A non-linear positive relationship between serum phosphate and clinical outcomes in sepsis

Cited by 4 publications

References 34 publications

Association of serum phosphate and changes in serum phosphate with 28-day mortality in septic shock from MIMIC-IV database

Association of serum phosphate and changes in serum phosphate with 28-day mortality in septic shock from MIMIC-IV database

Prognostic value of serum phosphate levels in sepsis: a systematic review and meta-analysis

Effect of early serum phosphate disorder on in-hospital and 28-day mortality in sepsis patients: a retrospective study based on MIMIC-IV database

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