Association between Hypophosphatemia and Cardiac Arrhythmias in the Early Stage of Sepsis: Could Phosphorus Replacement Treatment Reduce the Incidence of Arrhythmias?

Schwartz, A.; Brotfain, Evgeni; Koyfman, Leonid; Kutz, Ruslan; Gruenbaum, Shaun E.; Klein, Moti; Zlotnik, Alexander

doi:10.5049/ebp.2014.12.1.19

Cited by 36 publications

(30 citation statements)

References 18 publications

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“…Indeed, two of the main targets and regulators of FGF23, phosphorus and vitamin D, are strongly associated with systemic inflammation. Hypophosphatemia has long been reported to be associated with sepsis and correlates with sepsis severity(46, 47). Serum Pi is independently associated with inflammatory markers such as interleukin (IL)-6 (48), and dietary Pi loading dose dependently induces inflammation and increases serum tumor necrosis factor (TNF)-α levels in uremic rats(49).…”

Section: Inflammation and Bone And Mineral Metabolismmentioning

confidence: 99%

Inflammation regulates fibroblast growth factor 23 production

Francis

David²

2016

Current Opinion in Nephrology and Hypertension

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Purpose of review Fibroblast growth factor 23 (FGF23) is a hormone secreted by osteocytes and osteoblasts that regulates phosphorus and vitamin D homeostasis. FGF23 levels increase progressively in chronic kidney disease (CKD), and FGF23 excess might be a causal factor of left ventricular hypertrophy, CKD progression and death. Therefore, understanding the molecular mechanisms that control FGF23 production is a critical to design therapies to lower FGF23 levels. The present review focuses on the role of inflammatory stimuli on FGF23 regulation and summarizes recent studies that support a novel framework linking inflammation to FGF23 regulation. Recent findings Inflammation and iron deficiency, which are common occurrences in CKD have emerged as novel FGF23 regulators. Recent findings show that inflammation increases FGF23 production in bone through direct and iron-related indirect mechanisms. In these settings, Hypoxia Inducible Factor (HIF)-1α orchestrates FGF23 transcription in response to inflammation and is primarily responsible for coordinating FGF23 production and cleavage. Summary We demonstrate that inflammation increases FGF23 production and may contribute to elevated FGF23 levels in CKD. Osseous HIF-1α may represent a therapeutic target to lower FGF23 levels in CKD patients and minimize the negative consequences associated with FGF23 excess.

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Section: Inflammation and Bone And Mineral Metabolismmentioning

confidence: 99%

Inflammation regulates fibroblast growth factor 23 production

Francis

David²

2016

Current Opinion in Nephrology and Hypertension

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“…Abnormal electrolyte serum blood levels, such as high serum potassium, hypomagnesium and hypophosphatemia are highly correlated with new-onset arrhythmias in other studies. (20) Electrolyte disturbance was one of the important causes of arrhythmias in patients with acute renal dysfunction; there was a close relationship between acute renal dysfunction and arrhythmias. Electrolyte disturbance, along with systemic inflammation and a positive cumulative fluid balance, may be a possible explanation why patients who had undergone emergency surgery had increased susceptibility to arrhythmias.…”

Section: Patient Prognosismentioning

confidence: 99%

Clinical characteristics and mortality of patients in the intensive care unit with and without new-onset arrhythmias

Yang

Zhang²,

Feng³

2017

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Objective. The aims of this study were to analyze the risk factors for and types of new-onset arrhythmias in ICU (Intensive care unit), and to evaluate their impact on patient outcomes. Methods. We studied 1051 patients who were admitted to the two general ICUs between December 2013 and February 2016. These patients were divided into two groups: patients with new-onset arrhythmias and patients without new-onset arrhythmias. We compared the risk factors, types and prognoses of new-onset arrhythmias between these two groups. Results. New-onset arrhythmias were observed in 20.84% (n=219) of 1051 patients. The main risk factors leading to arrhythmias included age, emergency operation, past cardiovascular disease, patients with multiple systemic diseases, acute respiratory distress syndrome, severe sepsis/septic shock, acute renal dysfunction, cardiovascular disease, electrolyte disturbance, patients on ventilators, patients on vasopressors and higher Acute Physiology and Chronic Health Evaluation II scores (APACHE II score) on ICU admission. Multivariate logistic regression revealed that age, emergency operation, severe sepsis/septic shock, cardiovascular disease, electrolyte disturbance, patients on ventilators and those with higher APACHE II scores on ICU admission, were all significantly associated with new-onset arrhythmias. Arial fibrillation was the most frequent arrhythmia. ICU mortality in patients with newonset arrhythmias was 22.37% (49 out of 219) compared with 3.61% (30 out of 832) in patients without new-onset arrhythmias (p<0.001). Among surviving patients, ICU stay for those with new-onset arrhythmias was longer than those without new-onset arrhythmias (median stay of 10 days versus 5 days, p<0.001). Conclusion. We found a high prevalence of new-onset arrhythmias in ICU patients. Arrhythmia, especially atrial fibrillation, was a common complication in ICU patients and was associated with increasing length of ICU stay and higher mortality.

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“…Bazı çalışmalar hipofosfateminin SRRT tedavisi alan YBÜ de yatan mekanik ventilatördeki hastalarda sonuçları kötü etkilediğini göstermiştir [8][9][10][11] . Hipofosfatemi YBÜ de yatan septik şoklu hastalarda kardiyak aritmiye neden olur [12,13] . Hiperfosfatemi ile ilgili bir çalışmada da hiperfosfateminin hastane mortalitesi, mekanik ventilatörde kalış süresi, YBÜ ve hastanede kalış süresinde istatistiksel olarak anlamlı kötüleşme yarattığı gösterilmişdir [7] .…”

Section: Introductionunclassified

The Effects of Serum Phosphate on 28-day Mortality in Patients Hospitalized in the Intensive Care Unit, Treated with Mechanical Ventilator Therapy and Treated with CRRT for Septic Shock-Induced Acute Kidney Injury

Kaçar¹,

Uzundere²,

Kandemir³

et al. 2020

GKDA

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Fosfat sinyal iletimini, enerji üretimini ve mineral metabolizmasını içeren düzenleyici çoklu metabolik olayda yer alan esansiyel bir mineraldir. Biz bu çalışmada hastaların serum fosfat düzeylerinin fosfat referans değeri olarak verilen 2,5-4,5 mg/dL alt ve üst sınırlarından sapmasının 28 günlük mortalite üzerine etkisini araştırmayı planladık. Yöntem: Hastanemiz başhekimliğinden yazılı izin alındıktan sonra hasta dosyaları retrospektif olarak taranarak yoğun bakım ünitemizde yatan septik şok ilişkili akut böbrek hasarı nedenli sürekli renal replasman tedavisi gören ve 18 yaş üstü 53 adet hasta çalışmaya dahil edildi. Hastanemiz biokimya laboratuarındaki serum fosfat düzeyi referans arlığı 2,5-4,5 mg/dL olduğundan hastaların ortalama serum fosfat düzeylerinin alt sınır referans aralığı olan 2,5 mg/dL ve üst sınır referans aralığı olan 4,5 mg/dL'ye göre istatistiksel değişimleri hesaplandı.

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Association between Hypophosphatemia and Cardiac Arrhythmias in the Early Stage of Sepsis: Could Phosphorus Replacement Treatment Reduce the Incidence of Arrhythmias?

Cited by 36 publications

References 18 publications

Inflammation regulates fibroblast growth factor 23 production

Inflammation regulates fibroblast growth factor 23 production

Clinical characteristics and mortality of patients in the intensive care unit with and without new-onset arrhythmias

The Effects of Serum Phosphate on 28-day Mortality in Patients Hospitalized in the Intensive Care Unit, Treated with Mechanical Ventilator Therapy and Treated with CRRT for Septic Shock-Induced Acute Kidney Injury

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