Lower mean phosphate independently predicts mortality in critically ill patients: Results from a prospective cohort study

Lima, Washington Jose Noberto de; Calderaro, Débora Cerqueira; Passos, Rogério da Hora; Côrte, Margaret; Leal, José Adalberto; Mayrink, Marcelo Oliveira; Ferreira, Gilda Aparecida

doi:10.1016/j.jcrc.2023.154273

Cited by 2 publications

(2 citation statements)

References 16 publications

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“…Hypophosphatemia is a frequent finding and associated with worse outcomes in ICU ( 20 , 21 ). In a previous study, Aubier et al measured the transdiaphragmatic pressure at different plasmatic Ph concentration in eight patients receiving invasive MV for acute respiratory failure related to COPD within the 12 hours after admission to ICU.…”

Section: Discussionmentioning

confidence: 99%

Assessment of phosphatemia at admission to the intensive care unit to predict mechanical ventilation among patients with acute exacerbation of chronic obstructive pulmonary disease: a retrospective cohort study

Diop,

Legriel,

Ferré

2024

Ann Transl Med

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Background Hypophosphatemia has been reported to impair diaphragmatic function in patients with chronic obstructive pulmonary disease (COPD). However, little is known about the role of dysphosphatemia at admission [plasmatic phosphate concentration at intensive care unit (ICU) admission (T0-Ph)] to the ICU and respiratory outcomes among patients with severe acute COPD exacerbation. We aimed to assess the value of T0-Ph as a predictive factor of invasive mechanical ventilation (MV) during ICU stay. Methods We retrospectively included consecutive patients admitted to the ICU for a severe acute exacerbation of COPD between May 2015 and December 2018. Logistic multivariate regression analysis was performed to identify association between T0-Ph and the need for invasive MV during the ICU stay. Results We included 198 patients of whom 132 (67%) were male. The median age was 70 [interquartile range (IQR), 61–77] years. Nine (4.5%) patients died in the ICU. Median T0-Ph was significantly higher among patients requiring invasive MV as compared to non-intubated patients [1.23 (IQR, 1.07–1.41) and 1.09 (IQR, 0.91–1.27) mmol/L; P=0.005]. By multivariate analysis, pneumonia [odds ratio (OR) =6.42; 95% confidence interval (CI): 2.78–15.96; P<0.0001) and a history of intubation (OR =3.33; 95% CI: 0.97–11.19; P=0.05) were independently associated with the need for invasive MV, whereas T0-Ph was not (OR =1.75; 95% CI: 0.72–4.44; P=0.22). Conclusions T0-Ph was significantly higher in patients requiring invasive MV. However, T0-Ph was not associated with the need for invasive MV in multivariate analysis.

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Section: Discussionmentioning

confidence: 99%

Assessment of phosphatemia at admission to the intensive care unit to predict mechanical ventilation among patients with acute exacerbation of chronic obstructive pulmonary disease: a retrospective cohort study

Diop,

Legriel,

Ferré

2024

Ann Transl Med

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“…Hypophosphatemia, defined as serum phosphate concentration less than 0.75 mmol/L, is reported to occur in approximately one in five patients admitted to an ICU (3, 4). Data suggests that hypophosphatemia is associated with reduced survival from the ICU (5).…”

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confidence: 99%

A Randomized Noninferiority Trial to Compare Enteral to Parenteral Phosphate Replacement on Biochemistry, Waste, and Environmental Impact and Healthcare Cost in Critically Ill Patients With Mild to Moderate Hypophosphatemia*

Nguyen,

Panganiban,

Fazio

et al. 2024

Critical Care Medicine

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Objectives: Hypophosphatemia occurs frequently. Enteral, rather than IV, phosphate replacement may reduce fluid replacement, cost, and waste. Design: Prospective, randomized, parallel group, noninferiority clinical trial. Setting: Single center, 42-bed state trauma, medical and surgical ICUs, from April 20, 2022, to July 1, 2022. Patients: Patients with serum phosphate concentration between 0.3 and 0.75 mmol/L. Interventions: We randomized patients to either enteral or IV phosphate replacement using electronic medical record-embedded program. Measurement and Main Results: Our primary outcome was serum phosphate at 24 hours with a noninferiority margin of 0.2 mmol/L. Secondary outcomes included cost savings and environmental waste reduction and additional IV fluid administered. The modified intention-to-treat cohort comprised 131 patients. Baseline phosphate concentrations were similar between the two groups. At 24 hours, mean (sd) serum phosphate concentration were enteral 0.89 mmol/L (0.24 mmol/L) and IV 0.82 mmol/L (0.28 mmol/L). This difference was noninferior at the margin of 0.2 mmol/L (difference, 0.07 mmol/L; 95% CI, –0.02 to 0.17 mmol/L). When assigned IV replacement, patients received 408 mL (372 mL) of solvent IV fluid. Compared with IV replacement, the mean cost per patient was ten-fold less with enteral replacement ($3.7 [$4.0] vs. IV: $37.7 [$31.4]; difference = $34.0 [95% CI, $26.3–$41.7]) and weight of waste was less (7.7 g [8.3 g] vs. 217 g [169 g]; difference = 209 g [95% CI, 168–250 g]). CO 2 emissions were 60-fold less for comparable phosphate replacement (enteral: 2 g producing 14.2 g and 20 mmol of potassium dihydrogen phosphate producing 843 g of CO 2 equivalents). Conclusions: Enteral phosphate replacement in ICU is noninferior to IV replacement at a margin of 0.2 mmol/L but leads to a substantial reduction in cost and waste.

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Lower mean phosphate independently predicts mortality in critically ill patients: Results from a prospective cohort study

Cited by 2 publications

References 16 publications

Assessment of phosphatemia at admission to the intensive care unit to predict mechanical ventilation among patients with acute exacerbation of chronic obstructive pulmonary disease: a retrospective cohort study

Assessment of phosphatemia at admission to the intensive care unit to predict mechanical ventilation among patients with acute exacerbation of chronic obstructive pulmonary disease: a retrospective cohort study

A Randomized Noninferiority Trial to Compare Enteral to Parenteral Phosphate Replacement on Biochemistry, Waste, and Environmental Impact and Healthcare Cost in Critically Ill Patients With Mild to Moderate Hypophosphatemia*

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