Prevalence of hypophosphatemia in the ICU – Results of an international one-day point prevalence survey

Abstract

Background & aims: Hypophosphatemia (HypoP) is associated with organ dysfunction and mortality. Despite its potential severe consequences, HypoP remains poorly characterized in terms of real prevalence and timing of onset. The primary objective was to determine the prevalence of HypoP defined as blood phosphate <0.8 and < 0.65 mmol/l on one particular day at international level. Methods: One-day point prevalence survey conducted by the Section of Metabolism, Endocrinology and Nutrition (MEN) of the European Society of Intensive Care Medicine (ESICM) during week 11e2020. Results: In total, 56 adult and 4 paediatric ICUs, from 22 countries participated: 41 ICUs were mixed medico surgical, the 19 others being cardiac, medical or surgical. Phosphate measurements were performed daily in 21 ICUs, and 1e3 times per week in 39 ICUs. On D-Day 909 patients (883 adults) were present and 668/883 (75.7%) had serum/plasma phosphate determined, revealing a HypoP in 103 (15.4%) patients aged 62 [18 to 85] years. Of those, 49 patients presented phosphate <0.65 mmol/l: cases of hypophosphatemia were detected at any time of patient's ICU stay. No HypoP was observed in children. A treatment protocol existed only in 41.1% of adult ICUs, independently of ICU type, or size. Only 41/98 of the HypoP patients (29/41 of patients with phosphate <0.65 mmol/l) were receiving phosphate. Conclusion: HypoP is present at least in 15.4% of ICU patients, and may occur at any time during the ICU stay. The absence of phosphate repletion protocols in 60% of participating ICUs is an unexpected finding, and confirms the necessity for the development of ICU phosphate protocols and guidelines.

Hypophosphatemia at Admission is Associated with Increased Mortality in COVID-19 Patients

“…Previous studies have discovered that the incidence of hypophosphatemia ranged from 15.4% to 71.6% in a variety of patients, including critically ill children and adults, patients with acute kidney injury and those with massive burns. [14][15][16][17][18][19][20][21] The correlation between increased mortality and occurrence of hypophosphatemia was also confirmed in these studies. We designed this study to explore the incidence of hypophosphatemia at admission in COVID-19 patients and to verify whether hypophosphatemia was associated with mortality in COVID-19 patients.…”

A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice

“…Due to significant variations in RFS definitions, its exact incidence remains unknown. However, when RFS is defined by hypophosphatemia (hypoP) with a cut-off level of 0.65 mmol/L, the incidence ranges from 34 to 40%, with 4–10% presenting severe hypophosphatemia (phosphate < 0.32 mmol/L) or a drop after the start of glucose infusion or nutrition therapy [ 111 – 113 ]. Most recent studies in ICU patients using hypoP as the primary criterion to define RFS did not identify clinical predictors of RFS on ICU admission [ 41 , 110 , 114 ].…”

Hypophosphatemia in critically ill adults and children – A systematic review

“…In ICU patients, phosphate level might change faster than in non-ICU population, with consequences being potentially more severe. A recent point-prevalence survey in ICU patients defined severe hypophosphatemia as Pi<0.65 mmol/l [14]. Hereafter, the values will be reported according to the authors' definitions in respective studies.…”

“…Symptoms of hypophosphatemia are non-specific, yet potentially lifethreatening, and include muscle weakness, impaired myocardial contractility and ventricular arrhythmias, respiratory failure, rhabdomyolysis, ileus, immune dysfunction, encephalopathy, and hypercalciuria [1,5]. Despite the presumed importance of maintaining normal phosphate concentration in both health and disease states, and the common presence of risk factors of hypophosphatemia, several recent surveys have indicated that routine phosphate monitoring is not widespread in patients admitted to intensive care units (ICU) and that hypophosphatemia is often not corrected [6,7].…”