Association between hypophosphatemia and cardiac arrhythmias in the early stages of sepsis

Schwartz, A.; Gurman, Gabriel M.; Cohen, Gizella; Gilutz, Harel; Brill, Silviu; Schily, Markus; Gurevitch, Boris; Shoenfeld, Yehuda

doi:10.1016/s0953-6205(02)00130-9

Cited by 58 publications

(43 citation statements)

References 8 publications

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“…This may represent an alternative explanation for the association between postoperative AF and infection. Yet another explanation for the impact of infection on the development of postoperative AF may be the knowledge that low serum phosphate level and sepsis are at greater risk for cardiac arrhythmias, including AF [23]. Furthermore, one could speculate that local effects from the bacteria on atrial tissue rather than systemic inflammation may be at least a partial reason for the development of AF in postoperative infection.…”

Section: Discussionmentioning

confidence: 99%

New-Onset Atrial Fibrillation in Bacteremia Is Not Associated with C-Reactive Protein, but Is an Indicator of Increased Mortality during Hospitalization

Kindem¹,

Reindal²,

Wester³

et al. 2008

Cardiology

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Background: Several studies have associated elevated C-reactive protein (CRP) levels to the occurrence of atrial fibrillation (AF). We sought to estimate the frequency and prognostic impact of AF in patients with bacteremia, and to study the possible association between AF and CRP as well as between AF and mortality in this population. Methods: We retrospectively evaluated patient charts of patients with bacteremia with Escherichia coli or Streptococcus pneumoniae admitted to the Aker University Hospital in Oslo between 1994 and 2004. Known cardiac risk factors for AF, signs and mode of conversion of AF, and, if applicable, date of death were registered, as were characteristics of infection, such as systemic inflammatory response syndrome and white blood cell count. Initial CRP values were categorized into 4 strata. Odds ratios of the 3 highest CRP categories compared with the lowest were obtained from logistic models adjusting for known cardiac risk factors for AF as well as possible factors that may have had an impact on the odds ratios for the different CRP levels. Cox regression analysis was used to compare new-onset AF and death during the first 2 weeks after hospitalization. Results: A total of 672 patient charts were studied; 104 patients (15.4%) had new-onset AF. Peak incidence of new-onset AF occurred on the day of admission. Peak CRP values were reached during the following 2 days. High CRP level at admission did not predict the occurrence of AF. The observed mortality was higher among patients with new-onset AF (p = 0.001) during the first 2 weeks after hospitalization, but this effect disappears when adjusted for relevant factors. Conclusions: The frequency of new-onset AF in bacteremia is substantial. Initial CRP levels or white blood cell count do not seem to predict new-onset AF, as opposed to systemic inflammatory response syndrome. On the other hand, in patients with bacteremia, new-onset AF should be viewed as an indicator of increased mortality and morbidity.

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Section: Discussionmentioning

confidence: 99%

New-Onset Atrial Fibrillation in Bacteremia Is Not Associated with C-Reactive Protein, but Is an Indicator of Increased Mortality during Hospitalization

Kindem¹,

Reindal²,

Wester³

et al. 2008

Cardiology

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“…Walkey et al [24] demonstrated that new onset AF associated with sepsis was encountered in 14 % of all hospital-associated AF events. Risk factors predisposing to the development of new onset arrhythmic tachycardia include pre-existing factors such as chronic heart failure, valvular heart disease, coronary artery disease and endocrine disease, as well as acute metabolic disturbances such as electrolyte abnormalities: hypophosphatemia or hypomagnesaemia, severity of sepsis and vasopressors usage [35,39,42,45].…”

Section: Prevalence and Risk Factorsmentioning

confidence: 99%

Cardiac Arrhythmias in a Septic ICU Population: A Review

Schwartz

Brotfain

Koyfman

et al. 2015

The Journal of Critical Care Medicine

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Progressive cardiovascular deterioration plays a central role in the pathogenesis of multiple organ failure (MOF) caused by sepsis. Evidence of various cardiac arrhythmias in septic patients has been reported in many published studies. In the critically ill septic patients, compared to non-septic patients, new onset atrial fibrillation episodes are associated with high mortality rates and poor outcomes, amongst others being new episodes of stroke, heart failure and long vasopressor usage. The potential mechanisms of the development of new cardiac arrhythmias in sepsis are complex and poorly understood. Cardiac arrhythmias in critically ill septic patients are most likely to be an indicator of the severity of pre-existing critical illness.

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“…The incidence of hypophosphatemia in patients on CRRT ranges from 11 to 65%, depending on the intensity and duration of treatment [7,8]. Hypophosphatemia is independently associated with prolonged mechanical ventilation, respiratory failure, cardiac arrhythmias, and prolonged hospitalization [1,9,10,11] and is a biomarker of increased mortality [12]. Thus, the prevention of hypophosphatemia and its timely replacement are recommended.…”

Section: Introductionmentioning

confidence: 99%

Biochemical Effects of Phosphate-Containing Replacement Fluid for Continuous Venovenous Hemofiltration

Chua

Baldwin

et al. 2012

Blood Purif

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Aims: To examine biochemical effects of phosphate-containing replacement fluid (Phoxilium®) for continuous venovenous hemofiltration (CVVH). Methods: Retrospective comparison of respective serum biochemistry with sequential use of Accusol™ and Phoxilium, each over 48 h of CVVH. Results: We studied 15 critically ill patients. Accusol was switched to Phoxilium after 5 (4–8) days of CVVH. Respective serum biochemistry after 36–42 h of Accusol versus Phoxilium were: phosphate 1.02 (0.82–1.15) versus 1.44 (1.23–1.78) mmol/l, ionized calcium 1.28 (1.22–1.32) versus 1.12 (1.06–1.21) mmol/l, bicarbonate 24 (23–25) versus 20 (19–22) mmol/l, base excess 0 (–2 to 1) versus –4 (–6 to –3) mmol/l (p < 0.001). Cumulative phosphate intakes during respective periods were 69.6 (56.6–76.6) versus 67.2 (46.6–79.0) mmol (p = 0.45). Plasma strong ion differences were narrower with Phoxilium (p < 0.05), with similar strong ion gaps. No additional intravenous phosphate was given during Phoxilium use. Seven patients had serum phosphate >1.44 mmol/l. Conclusions: Phoxilium versus Accusol use during CVVH effectively prevented hypophosphatemia but contributed to mild hyperphosphatemia, and is associated with relative hypocalcemia and metabolic acidosis.

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Association between hypophosphatemia and cardiac arrhythmias in the early stages of sepsis

Cited by 58 publications

References 8 publications

New-Onset Atrial Fibrillation in Bacteremia Is Not Associated with C-Reactive Protein, but Is an Indicator of Increased Mortality during Hospitalization

New-Onset Atrial Fibrillation in Bacteremia Is Not Associated with C-Reactive Protein, but Is an Indicator of Increased Mortality during Hospitalization

Cardiac Arrhythmias in a Septic ICU Population: A Review

Biochemical Effects of Phosphate-Containing Replacement Fluid for Continuous Venovenous Hemofiltration

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