Impact of hypophosphatemia on outcome of patients in intensive care unit: a retrospective cohort study

Abstract

Background Hypophosphatemia generally occurs in Intensive Care Units (ICUs), but its impact is often ignored. The aim of this study was to investigate whether hypophosphatemia can be a risk factor for ICU 28-day mortality. Methods A single-center retrospective cohort study was conducted by collecting data from 1073 patients admitted to general ICU and then presented to the Sixth Affiliated Hospital, Sun Yat-sen University (Guangzhou City, Guangdong Province, China) from 1 January 2016 to 31 December 2017. The patients were divided into a normal control group (serum phosphate levels 0.80–1.60 mmol/L) and a hypophosphatemia group (serum phosphate levels < 0.80 mmol/L), based on the concentration of phosphorus at the time of ICU admission. The association between phosphate levels and ICU 28-day mortality was evaluated by binary logistic regression analysis. Multivariate logistic regression was employed to predict the ICU 28-day mortality. Results The cohort included 946 patients with a median phosphate concentration of 0.77 mmol/L (interquartile range 0.55–1.03 mmol/L). Patients with hypophosphatemia had a higher ICU 28-day mortality than the normal control group (33.3% vs 24.0%, P < 0.05). Patients with hypophosphatemia had a longer ICU and hospital stays, and prolonged duration of mechanical ventilation (all P < 0.05). Hypophosphatemia was an independent risk factor for ICU 28-day mortality (adjusted OR = 1.5, 95% CI = 1.1–2.1, P = 0.01) in the multivariate logistic regression analysis. Conclusions Hypophosphatemia at admission is an independent risk factor for 28-day mortality in general ICU patients. Trial registration The medical study was approved by the Institutional Ethics Committee of the Six Affiliated Hospital, Sun Yat-sen University (Approval number: 2017ZSLYEC-110). No consent was given as the data were analyzed anonymously.

Is&nbsp;Monitoring for Phosphate&nbsp;a Necessary Measure in Critical Ill Patients ?

“…Also, they found the timing or the duration of hypophosphatemia had no signi cant association with ICU mortality. Another retrospective cohort study among 946 ICU patients performed by Wang et al's [8] indicated that patients in ICU with hypophosphatemia had higher 28-day ICU mortality (35.3% versus 24%) and longer ICU stay [(5.5, 2.8 to 10.6) versus (1.7, 1.5 to 3.4)]. According to the results of their study, hypophosphatemia was an independent risk factor for 28-day ICU mortality (OR = 1.5, 95%CI 1.1 to 2.1, P = 0.01, adjusted).…”

“…Inorganic phosphate is the value of serum phosphate measured in the clinic [1][2][3][4][5]. Although serum phosphate is very low, it plays an important role in the body [1][2][3][6][7][8][9]. For example, (I) participating in the composition of cell membranes in the form of phospholipids to maintain the integrity and function of the cell structure;…”

“…As we all know, patients often have electrolyte disturbances during ICU, the hypophosphatemia and hyperphosphatemia are common electrolyte disturbances. Recent studies have shown that ICU patients have a higher prevalence of hypophosphatemia and hyperphosphatemia [1,3,6,8,18,19]. It has varying degrees of impact on clinical outcomes, but due to its atypical clinical symptoms, it has not received much attention.…”

“…For hyperphosphatemia, most studies had proved that hyperphosphatemia was an independent risk factor for mortality or morbidity [1,7,11,14,15,[20][21][22][23][24][25][26]. For hypophosphatemia, some studies showed that it was an independent risk factor for mortality or morbidity [1,8,23,27], but some studies showed that it was not signi cantly associated with mortality or morbidity [15,20,22,28]. Thus, it was not determined whether serum phosphate abnormalities are directly related to the increase in mortality in ICU patients or merely a sign of the severity of disease for ICU patients.…”

A Pooled Analysis of Serum Phosphate Measurements and Potential Hypophosphataemia Events in 45 Interventional Trials with Ferric Carboxymaltose

“…Severe cases with PO 4 3− depletion may cause symptoms such as fatigue [5], myocardial depression [6], rhabdomyolysis [7], seizures [8], and haemolytic anaemia [9] and, over time, can ultimately contribute to bone abnormalities such as osteomalacia or rickets [10,11]. Rarely, the most severe cases of HP can be fatal [12][13][14]; respiratory muscle dysfunction or impaired myocardial metabolism and decreased cardiac contractility have been associated with severe HP [6,13,15,16]. Hypophosphataemia is a known adverse drug reaction with ferric carboxymaltose (FCM) listed in the Ferinject ® (FCM) Prescribing Information since registration of the product [17], and it is often transient and, in most cases, asymptomatic.…”