Association between phosphate disturbances and mortality among critically ill patients with sepsis or septic shock

Shmeylan A Al Harbi,Yaseen Arabi,Hasan M Al-Dorzi,Hani Tamim,Sheryl Ann I Abdukahil,Musharaf Sadat,Albatool M Al Meshari

doi:10.1186/s40360-021-00487-w

Abstract

ObjectiveThe aim of this study is to examine the association of hypophosphatemia and hyperphosphatemia on the first day of ICU admission with mortality in septic critically ill patients.MethodsIn this retrospective cohort study, all adult patients who were admitted to the medical-surgical ICUs between 2014 and 2017 with sepsis or septic shock were categorized as having hypophosphatemia, normophosphatemia and hyperphosphatemia based on day 1 serum phosphate values. We compared the clinical characteristics and outcomes between the three groups. We used multivariate analysis to examine the association of hypophosphatemia and hyperphosphatemia with these outcomes.ResultsOf the 1422 patients enrolled in the study, 188 (13%) had hypophosphatemia, 865 (61%) normophosphatemia and 369 (26%) had hyperphosphatemia. The patients in the hyperphosphatemia group had significantly lower GCS, higher APACHE II scores, higher serum creatinine, increased use of vasopressors, and required more mechanical ventilation with lower PaO2/FiO2 ratio compared with the other two groups. In addition, the hyperphosphatemia group showed significantly higher ICU and hospital mortality in comparison with the other two groups.ConclusionHyperphosphatemia and not hypophosphatemia on the first ICU admission day was associated with an increase in the ICU and hospital mortality in septic critically ill patients.

Highlights

Acute critical illness predisposes patients to serum phosphate disturbances [1,2,3,4,5,6], whether hypo or hyperphosphatemia
Patient characteristics Of the 1422 patients enrolled in the study, 188 (13%) were categorized as hypophosphatemia with a median of 0.6 mmol/L, 865 (61%) as normophosphatemia with a median of 1.09 mmol/L and 369 (26%) as hyperphosphatemia with a median of 1.9 mmol/L, at day one of their Intensive care unit (ICU) admission
Mechanical ventilation duration was longer in the hyperphosphatemia group (2 days; Q1, Q3: 0, 6 versus 0; Q1, Q3: 0, 4 for hypophosphatemia patients)

Summary

Introduction

Acute critical illness predisposes patients to serum phosphate disturbances [1,2,3,4,5,6], whether hypo or hyperphosphatemia. In these patients, hypophosphatemia may develop as a result of decreased intake or absorption, increased renal excretion, and/ or internal redistribution. Hypophosphatemia may develop as a result of decreased intake or absorption, increased renal excretion, and/ or internal redistribution It can be seen in patients with hyperventilation, The reported prevalence of hypophosphatemia in critically ill patients varies widely across different studies and ranges between 10 and 80% [9,10,11]. Studies have shown that hypophosphatemia occurs in up to 80% of septic patients

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Discussion

Conclusion