Abstract
BackgroundHypophosphatemia generally occurs in Intensive Care Units (ICUs), but its impact is often ignored. The aim of this study was to investigate whether hypophosphatemia can be a risk factor for ICU 28-day mortality.MethodsA single-center retrospective cohort study was conducted by collecting data from 1073 patients admitted to general ICU and then presented to the Sixth Affiliated Hospital, Sun Yat-sen University (Guangzhou City, Guangdong Province, China) from 1 January 2016 to 31 December 2017. The patients were divided into a normal control group (serum phosphate levels 0.80–1.60 mmol/L) and a hypophosphatemia group (serum phosphate levels < 0.80 mmol/L), based on the concentration of phosphorus at the time of ICU admission. The association between phosphate levels and ICU 28-day mortality was evaluated by binary logistic regression analysis. Multivariate logistic regression was employed to predict the ICU 28-day mortality.ResultsThe cohort included 946 patients with a median phosphate concentration of 0.77 mmol/L (interquartile range 0.55–1.03 mmol/L). Patients with hypophosphatemia had a higher ICU 28-day mortality than the normal control group (33.3% vs 24.0%, P < 0.05). Patients with hypophosphatemia had a longer ICU and hospital stays, and prolonged duration of mechanical ventilation (all P < 0.05). Hypophosphatemia was an independent risk factor for ICU 28-day mortality (adjusted OR = 1.5, 95% CI = 1.1–2.1, P = 0.01) in the multivariate logistic regression analysis.ConclusionsHypophosphatemia at admission is an independent risk factor for 28-day mortality in general ICU patients.Trial registrationThe medical study was approved by the Institutional Ethics Committee of the Six Affiliated Hospital, Sun Yat-sen University (Approval number: 2017ZSLYEC-110). No consent was given as the data were analyzed anonymously.
Highlights
Hypophosphatemia generally occurs in Intensive Care Units (ICUs), but its impact is often ignored
Population characteristics A total number of 1073 of adult patients were admitted to the general ICU from 2015 to 2016, of which 946 patients met the inclusion criteria
Discussion previous studies have indicated that hypophosphatemia is associated with worse clinical outcomes in critically ill patients [14, 20], few studies have been carried out to investigate the association between the serum phosphorus levels at admission and the outcomes of general ICU population
Summary
Hypophosphatemia generally occurs in Intensive Care Units (ICUs), but its impact is often ignored. Phosphate is a vital component of the lipid bilayer in the cell membrane, which has essential functions in many biological processes, such as adenosine triphosphate production, glycolysis, pH buffering, 2,3-diphosphoglycerate (2,3-DPG) synthesis, mitochondrial functions, enzyme regulation, signal transduction, and nucleotide metabolism [1,2,3]. Maintaining normal serum phosphate levels is extremely important as Phosphate homeostasis is complex, and the phosphate ion may be influenced by other factors, such as decreased renal clearance, increased consumption in catabolic patients, intestinal losses, or clearance over a continuous renal replacement therapy (CRRT) membrane. Hypophosphatemia is among the most frequently encountered electrolyte metabolic disturbances in critically ill patients with an incidence and prevalence ranging within 2.4–100% [13, 14]. The detection of phosphate metabolism abnormalities in Intensive Care Unit (ICU) populations is crucial
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