Abstract

BackgroundFluctuations in serum phosphate levels increased mortality in end-stage renal disease patients. However, the impacts of serum phosphate changes in hospitalized patients remain unclear. This study aimed to test the hypothesis that serum phosphate changes during hospitalization were associated with in-hospital mortality.MethodsWe included all adult hospitalized patients from January 2009 to December 2013 that had at least two serum phosphate measurements during their hospitalization. We categorized in-hospital serum phosphate changes, defined as the absolute difference between the maximum and minimum serum phosphate, into 5 groups: 0–0.6, 0.7–1.3, 1.4–2.0, 2.1–2.7, ≥2.8 mg/dL. Using serum phosphate change group of 0–0.6 mg/dL as the reference group, the adjusted odds ratio of in-hospital mortality for various serum phosphate change groups was obtained by multivariable logistic regression analysis.ResultsA total of 28,149 patients were studied. The in-hospital mortality in patients with serum phosphate changes of 0–0.6, 0.7–1.3, 1.4–2.0, 2.1–2.7, ≥2.8 mg/dL was 1.5, 2.0, 3.1, 4.4, and 10.7%, respectively (p < 0.001). When adjusted for confounding factors, larger serum phosphate changes were associated with progressively increased in-hospital mortality with odds ratios of 1.35 (95% 1.04–1.74) in 0.7–1.3 mg/dL, 1.98 (95% CI 1.53–2.55) in 1.4–2.0 mg/dL, 2.68 (95% CI 2.07–3.48) in 2.1–2.7 mg/dL, and 5.04 (95% CI 3.94–6.45) in ≥2.8 mg/dL compared to serum phosphate change group of 0–0.6 mg/dL. A similar result was noted when we further adjusted for either the admission or mean serum phosphate during hospitalization.ConclusionGreater serum phosphate changes were progressively associated with increased in-hospital mortality.

Highlights

  • Fluctuations in serum phosphate levels increased mortality in end-stage renal disease patients

  • Among patients on Thongprayoon et al BMC Nephrology (2020) 21:427 maintenance hemodialysis, a recent study demonstrated that high variability of serum phosphate was independently correlated with increased all-cause and cardiovascular mortality, while stable serum phosphate levels and low serum phosphate variability were associated with reduced patient mortality [10]

  • When adjusting for confounding factors in model 2, increased serum phosphate changes were progressively associated with increased in-hospital mortality with adjusted odds ratios of 1.35 (95% 1.04– 1.74) in serum phosphate changes of 0.7–1.3, 1.98 in 1.4–2.0, 2.68 in Changes in serum phosphate level during hospitalization

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Summary

Introduction

Fluctuations in serum phosphate levels increased mortality in end-stage renal disease patients. While previous studies have focused on the impact of serum phosphate disorders (hypophosphatemia and hyperphosphatemia) [5,6,7, 13,14,15,16,17], knowledge about the significance of changes in serum phosphate level and allcause mortality remains scarce. The impacts of serum phosphate changes in hospitalized patients remain unclear. We conducted this cohort study to assess the association between alteration of serum phosphate levels and in-hospital mortality in all hospitalized patients

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