The prevalence of hypophosphatemia and refeeding-related hypophosphatemia in hospitalized patients requiring parental nutrition: a retrospective study

Zhou, Yucheng; Zhang, Xiaomin; Chen, Zhiqi; Wang, Jialu; Qian, Yongbing; Xu, Renying

doi:10.1007/s00520-022-07141-z

Cited by 5 publications

(3 citation statements)

References 24 publications

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“…To test the robustness of main results of association between serum phosphate levels and LOS, we performed multiple sensitivity analyses: [ 1 ] excluding patients with CCI of 3 points or more ( n = 3,070) [ 34 ]; [ 2 ] excluding patients whose eGFR-EPI < 60 ml/1.73m 2 ( n = 2,348) [ 35 ]; [ 3 ] excluding patients whose BMI ≥ 24 kg/m 2 ( n = 9,587) or BMI < 18.5 kg/m 2 ( n = 1,835) [ 36 , 37 ]; [ 4 ] excluding patients with low vitamin D status ( n = 15,924) [ 38 ]; [ 5 ] excluding patients whose hospital LOS ≥ 30 days ( n = 742); [ 6 ] excluding patients whose serum phosphate were not tested within 24 h ( n = 3,330).…”

Section: Methodsmentioning

confidence: 99%

The association between serum phosphate and length of hospital stay and all-cause mortality in adult patients: a cross-sectional study

Zhou,

Zhang,

Chen

et al. 2024

Nutr J

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Background Data is limited on the prevalence of hypophosphatemia in general hospitalized patients, and its association with length of hospital stay (LOS) and mortality remained unclear. We aimed to investigate the prevalence of admission phosphate abnormality and the association between serum phosphate level and length of hospital stay and all-cause mortality in adult patients. Methods This was a multi-center retrospective study based on real-world data. Participants were classified into five groups according to serum phosphate level (inorganic phosphorus, iP) within 48 h after admission: G1, iP < 0.64 mmol/L; G2, iP 0.64–0.8 mmol/L; G3, iP 0.8–1.16 mmol/L; G4, iP 1.16–1.45 mmol/L; and G5, iP ≥ 1.45 mmol/L, respectively. Both LOS and in-hospital mortality were considered as outcomes. Clinical information, including age, sex, primary diagnosis, co-morbidity, and phosphate-metabolism related parameters, were also abstracted from medical records. Results A total number of 23,479 adult patients (14,073 males and 9,406 females, aged 57.7 ± 16.8 y) were included in the study. The prevalence of hypophosphatemia was 4.74%. An “L-shaped” non-linear association was determined between serum phosphate level and LOS and the inflection point was 1.16 mmol/L in serum phosphate level. Compared with patients in G4, patients in G1, G2 or G3 were significantly associated with longer LOS after full adjustment of covariates. Each 0.1 mmol/L decrease in serum phosphate level to the left side of the inflection point led to 0.64 days increase in LOS [95% confidence interval (CI): 0.46, 0.81; p for trend < 0.001]. But there was no association between serum phosphate and LOS where serum levels of phosphate ≥ 1.16 mmol/L. Multivariable logistic regression analysis showed that adjusted all-cause in-hospital mortality was 3.08-fold greater in patients in G1 than those in G4 (95% CI: 1.52, 6.25; p for trend = 0.001). Similarly, no significant association with either LOS or mortality were found in patients in G5, comparing with G4. Conclusions Hypophosphatemia, but not hyperphosphatemia, was associated with LOS and all-cause mortality in adult inpatients. It is meaningful to monitor serum levels of phosphate to facilitate early diagnosis and intervention.

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Section: Methodsmentioning

confidence: 99%

The association between serum phosphate and length of hospital stay and all-cause mortality in adult patients: a cross-sectional study

Zhou,

Zhang,

Chen

et al. 2024

Nutr J

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“…Normal weight is measured by a 18.5 kg/m 2 BMI, it is then measured by a BMI between 18.5 and 24 kg/m 2 , and overweight (with a BMI of 24 kg/m 2 ) ( 35 ). The cut-off point for stratifying prealbumin was the identification of low prealbumin by prealbumin <160 mg/L ( 36 ). Diagnostic criteria for the diagnosis of postoperative pneumonia within thirty days of surgery should conform to the following three criteria in the meantime: (A) at least two chest radiographs and at least one diagnosis of pneumonia; (B) at least meet the following one, age ≥70 years, peripheral blood WBC count <4 x 10 9 /L or >12 x 10 9 /L, and fever (the temperature of body >38°C) with altered consciousness; (C) at least two of the following, such as the emergence of purulent sputum or sputum properties change, or increased respiratory secretions, or need to increase the number of sputum, or dyspnea.…”

Section: Methodsmentioning

confidence: 99%

Association between preoperative diagnosis of sarcopenia and postoperative pneumonia in resectable esophageal squamous cell carcinoma patients: a retrospective cohort study

et al. 2023

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BackgroundPostoperative outcomes for patients suffering from resectable esophageal squamous cell carcinoma (ESCC) are related to sarcopenia. In patients with resectable ESCC, this study investigated the link between sarcopenia and postoperative pneumonia.MethodsThe McKewon procedure was the only one used to treat resectable ESCC patients from January 2018 to December 2021 in this retrospective analysis. Sarcopenia was assessed using skeletal muscles at L3 and planning CT scans. It was defined when PMI was below 6.36 cm2/m2 and 3.92 cm2/m2 for men and women, separately. Analyses of multivariate and univariate logistic regression were applied for identifying the risk factors for postoperative pneumonia.ResultsThe study included 773 patients with resectable ESCC in total. Sarcopenia was an independent risk factor for postoperative pneumonia in individuals with resectable ESCC based on univariate and multivariate analysis (P < 0.05). The stratified analysis indicated that neither of the clinical outcomes in the logistic regression model were affected by gender, age, BMI, smoking, or pre-albumin (P for interaction > 0.006).ConclusionFollowing the McKewon procedure, patients with resectable ESCC who were sarcopenic had a higher postoperative pneumonia rate. To prevent the development of postoperative pneumonia during the perioperative period, it may be important to control the incidence of sarcopenia.

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“…In order to examine distinctions among groups regarding continuous data, we employed the Mann-Whitney U test, whereas the Pearson chi-squared test or Fisher’s exact probability method was utilized for categorical data. The determination of cutoff values for continuous variables was based on the median of the cohort (age [70 years]), defined class (BMI [18.5 kg/m 2 , 24 kg/m 2 ]), predicted FEV1% [80%]), and thresholds reported in previous studies (pre-albumin [160 mg/L]) ( 25 , 26 ).…”

Section: Methodsmentioning

confidence: 99%

Psoas muscle mass index and peak expiratory flow as measures of sarcopenia: relation to outcomes of elderly patients with resectable esophageal cancer

Zhang,

Xiong,

Chen

et al. 2023

Front. Oncol.

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ObjectivesThe objective of this study is to investigate whether the evaluation of postoperative outcomes or overall survival in patients who undergo surgery for esophageal cancer can be achieved by assessing sarcopenia using psoas muscle mass index and peak expiratory flow.MethodsThis retrospective study analyzed the clinical data of 356 elderly patients (≥ 65 years) who had undergone radical surgery for esophageal cancer. Muscle mass and muscle strength were assessed by psoas muscle mass index (bilateral psoas area/height2) and peak expiratory flow, using preoperative computed tomography and spirometry, respectively. Sarcopenia is defined as a condition where both the psoas muscle mass index and peak expiratory flow fall below their gender-specific cutoff values. Survival and postoperative complications were compared between patients with and without sarcopenia.ResultsOut of the 356 elderly individuals diagnosed with esophageal cancer, 84 patients (23.6%) were found to have sarcopenia. The group with sarcopenia showed a notably higher occurrence of postoperative pneumonia (29.8% vs 16.9%, P < 0.001) and anastomotic leak (9.5% vs 3.7%, P < 0.05) compared to those without sarcopenia. Additionally, a multivariate analysis concluded that sarcopenia independently acted as a risk factor for postoperative pneumonia, possessing an odds ratio of 1.90 (P < 0.05). The survival rate after 3 years for individuals with sarcopenia was considerably lower than those without sarcopenia (57.8% vs 70.2%, P < 0.05). Sarcopenia was identified as an unfavorable prognostic factor for overall survival, with a hazard ratio of 1.51 (P < 0.05).ConclusionsPreoperative sarcopenia diagnosed by psoas muscle mass index and peak expiratory flow is associated with reduced overall survival and adverse postoperative outcomes among elderly individuals suffering from esophageal cancer.

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The prevalence of hypophosphatemia and refeeding-related hypophosphatemia in hospitalized patients requiring parental nutrition: a retrospective study

Cited by 5 publications

References 24 publications

The association between serum phosphate and length of hospital stay and all-cause mortality in adult patients: a cross-sectional study

The association between serum phosphate and length of hospital stay and all-cause mortality in adult patients: a cross-sectional study

Association between preoperative diagnosis of sarcopenia and postoperative pneumonia in resectable esophageal squamous cell carcinoma patients: a retrospective cohort study

Psoas muscle mass index and peak expiratory flow as measures of sarcopenia: relation to outcomes of elderly patients with resectable esophageal cancer

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