Abstract
ObjectiveTo assess the effect of serum inorganic phosphate (Pi) on the prognosis of patients with sepsis.MethodsA retrospective analysis of patients with sepsis selected from the Medical Information Mart for Intensive Care (MIMIC)-IV database was performed. Sepsis was diagnosed according to the Third International Consensus Definition for sepsis and septic shock (Sepsis-3). The time-weighted values of the serum Pi measurements within the first 24 h of sepsis were analyzed. The association between serum Pi and in-hospital mortality was evaluated with a generalized linear model (log-binomial model).ResultsThe analysis of 11,658 patients from six intensive care units (ICUs) showed a nearly linear correlation between serum Pi and in-hospital mortality in all patients with sepsis, especially in those with acute kidney injury (AKI). The increase of serum Pi was related to a higher risk of AKI, higher norepinephrine doses, ICU mortality, and in-hospital mortality. The generalized linear model showed that serum Pi was an independent predictor for in-hospital mortality in all patients with sepsis even within the normal range. The adjusted risk ratios (RRs) were also significant in subgroup analyses according to kidney function, gender, respiratory infection, vasopressor use, and Sequential Organ Failure Assessment (SOFA) score.ConclusionHigher levels of serum Pi, even within the normal range, were significantly associated with a higher risk of in-hospital mortality in patients with sepsis regardless of kidney function, gender, respiratory infection, vasopressor use, and SOFA score.
Highlights
Sepsis is a complex condition that remains the major cause of morbidity and mortality worldwide, and the true global burdens of sepsis are likely much higher than reported [1, 2].A better understanding of sepsis has been researched in the past three decades [3]
The Medical Information Mart for Intensive Care (MIMIC)III database provided critical care data for over 40,000 patients admitted to intensive care units (ICUs) at the Beth Israel Deaconess Medical Center (BIDMC) from 2001 to 2012
After adjusting for other confounders, including age, gender, Sequential Organ Failure Assessment (SOFA) scores, weight, vasopressor use, hypertension, coronary artery disease (CAD), chronic kidney disease (CKD), acute kidney injury (AKI), white blood cell (WBC) count, serum creatinine level, blood lactate level, respiratory infection, urinary infection, and bloodstream infection, the log-binomial model indicated that Pi was an independent predictor of in-hospital mortality (RR 1.11, 95%CI 1.08–1.23, p < 0.01)
Summary
Sepsis is a complex condition that remains the major cause of morbidity and mortality worldwide, and the true global burdens of sepsis are likely much higher than reported [1, 2].A better understanding of sepsis has been researched in the past three decades [3]. Sepsis is a complex condition that remains the major cause of morbidity and mortality worldwide, and the true global burdens of sepsis are likely much higher than reported [1, 2]. Phosphate and Prognosis of Sepsis proposed by Surviving Sepsis Campaign in 2018 encourages clinicians to act as quickly as possible to make an accurate diagnosis and start appropriate treatment if clinically indicated [5]. Great progress has been made into the pathobiology, management, and epidemiology of the disease, the high mortality is still unacceptable [2]. The early identification of patients with sepsis at high risk of death allows clinicians to administer treatment in time. Serum Pi disorders are common in critically ill patients, which can be attributed to several factors including gastrointestinal dysfunction, acute kidney dysfunction, and redistribution of Pi from the extracellular space into the cells [8, 9]
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