Hypophosphatemia Group Research Articles

The Incidence and Risk Factors of Refeeding Syndrome-like Hypophosphatemia in Inflammatory Bowel Disease: A Preliminary Study.

Refeeding syndrome (RFS) is defined by the presence of acute electrolyte disturbances, including hypophosphatemia. Underlying disease(s), malnutrition and hospitalisation are known risk factors for RFS. It can occur in patients with inflammatory bowel disease (IBD). We aimed to determine the frequency of hypophosphatemia and the relationship between hypophosphatemia, disease severity and nutritional status in hospitalized patients with IBD. This study was performed prospectively in hospitalized adult patients for the treatment of IBD in a tertiary-care hospital. Disease severity was assessed using Truelove and Witts score for ulcerative colitis (UC) and Crohn's Disease Activity Index for Crohn's disease (CD). Nutritional status was determined using Subjective Global Assessment (SGA). Serum phosphate concentration was recorded for first 7 days after hospitalization, and less than 0.65 mmol/l was defined as hypophosphatemia. Fifty participants (33 with UC and 17 with CD) were included in the study. The mean age of the study sample was 43.4±14.9 years, of which 64% were male. A total of 8.8% of patients with UC and 37.5% of patients with CD had severe (>moderate) disease upon study admission. Seventeen patients (34%) were malnourished. During the 7 study days, 23 participants (46%) had at least one episode of hypophosphatemia. Serum phosphate concentration was significantly and moderately correlated with serum potassium concentration in both the patients and the hypophosphatemia group on study day 3 (p<0.05). Multivariate logistic regression analysis showed that the presence of malnutrition [odds ratio (OR) = 3.64, 95% confidence interval (CI): 1.52-5.58, p=0.008), the administration of parenteral nutrition (OR=2.91, 95%Cl: 1.37-4.63, p=0.015), and severe IBD (OR=1.74, 95%CI: 1.03-3.42, p=0.020) were associated with hypophosphatemia. Approximately half of the participants exhibited at least one instance of hypophosphatemia during the study period. Hypophosphatemia was found to be associated with malnutrition, parenteral nutrition, and severe disease in patients with IBD requiring hospitalization.

Exploring the association between serum phosphate levels and mortality in patients hospitalized with infectious diseases: a nationwide study.

The purpose of this study was to examine associations of serum phosphate levels with mortality, target organ damage and length of hospital stay in adults with infectious diseases hospitalized outside of the intensive care unit. This nationwide retrospective cohort study comprised patients admitted with infections, to medical and surgical departments in eight tertiary hospitals during 2001-2020. The main exposure variable was the first serum phosphate levels at admission (up to 1 week). The analysis included multivariable logistic regression models and quantile regression. Of 126,088 patients (49% males, mean age: 69.3 years), 24,809 (19.7%) had decreased phosphate levels, 92,730 (73.5%) normal phosphate levels, and 8,549 (6.8%) elevated phosphate levels on admission. Overall- and in-hospital mortality rates were highest among those with hyperphosphatemia (74.5 and 16.4%, respectively), followed by those with normophosphatemia (57.0 and 6.6%), and lastly the hypophosphatemia group (48.7 and 5.6%); p < 0.001 for all. After adjusting for confounders, the lowest predicted mortality rate was observed in the normophosphatemia group. In the multivariable model, hyperphosphatemia conferred a higher probability of target organ damage (OR [95% CI]: 2.43 [2.06-2.86]), while moderate hypophosphatemia conferred a lower probability (OR [95% CI]: 0.73 [0.65-0.82]), compared to normal phosphate levels and extreme hypophosphatemia showed a non-significant association (OR [95% CI]: 0.87 [0.57-1.28]). The associations were independent of renal failure. In a multivariable model, hyperphosphatemia was associated with a slight increase of 0.33 days in length of stay compared to normal phosphate levels. A J-shaped relation was found between phosphate levels and prognosis in patients hospitalized with infectious diseases, regardless of their renal function.

Serum Phosphorus as a Driver of Skeletal Morbidity in Fibrous Dysplasia.

Fibrous dysplasia (FD) results in fractures, pain, and deformities. Abnormal osteoprogenitor cells overproduce FGF23, leading to hyperphosphaturia in most patients and frank hypophosphatemia in a subset. Studies suggest hypophosphatemia is associated with increased FD-related morbidity. However, the relationship between phosphorus and skeletal complications has not been investigated, and the optimal therapeutic target has not been determined. Characterize the impact of serum phosphorus on FD-related morbidity and identify levels associated with increased skeletal complications. Natural history study with 240 subjects at a clinical research center who had ≥1 fasting phosphorus level, determined as age- and sex-adjusted Z-scores. Subjects were categorized based on frank hypophosphatemia (Z-score ≤ -2; n = 48); low-normophosphatemia (> -2 to ≤ -1; n = 66); and high-normophosphatemia (> -1 to ≤ 2; n = 125). Main outcomes were fractures, orthopedic surgeries, and scoliosis. Subjects with frank and low-normophosphatemia had increased fracture and surgery rates vs high-normophosphatemia. The prevalence of moderate to severe scoliosis was similarly higher in the frank and low-normophosphatemia groups. In a subanalysis of patients matched for Skeletal Burden Score ≥35, fracture and surgery rates remained higher in the frank hypophosphatemia group, suggesting association between phosphorus and skeletal complications is not explained by differences in FD burden alone. Both frank hypophosphatemia and low-normophosphatemia are associated with increased FD-related complications. This supports FGF23-mediated hypophosphatemia as a driver of skeletal morbidity, which may impact a larger proportion of the FD/McCune-Albright syndrome population than previously recognized. These findings enable clinicians to identify at-risk patients and will inform development of prospective studies to determine optimal therapeutic targets.

Association of Hypophosphatemia with Morbidity and Mortality in Patients with COVID-19

Aim: In critical cases, electrolyte disturbances such as hypophosphatemia have been shown to be associated with mortality and in our study, we aimed to examine the relationship between hypophosphatemia, a symptom disorder with COVID-19, and death. Material and Methods: This study is a retrospective, cross-sectional investigation that encompasses patients diagnosed with COVID-19 and subsequently admitted for treatment at our hospital. Based on their serum phosphate levels, the patients were bifurcated into two distinct categories: those with serum phosphate levels below 2.5 mg/dl, classified as hypophosphatemic, and those with levels above this benchmark, categorized as non-hypophosphatemic. The comparisons drawn between these two cohorts were facilitated using a range of statistical methodologies, and the resulting findings were subsequently analyzed and interpreted within this framework. Results: Compared to the hypophosphatemia group, the diagnoses of DM (p&amp;lt;0.001) and CKD (p=0.015) were statistically significantly higher in the group without hypophosphatemia. A statistically significant difference was found between phosphorus groups and mortality and length of stay (p&amp;lt;0.001). In addition, age and length of hospitalization were found to be statistically significantly higher in those who died compared to those who were alive (p&amp;lt;0.001; p=0.002). Conclusions: Hypophosphatemia has been shown to be associated with mortality in patients with COVID-19, as in many studies and in our study, and it may be a biomarker in predicting severe disease.

ANALYSIS OF THE RELATIONSHIP BETWEEN EARLY SERUM PHOSPHATE LEVELS AND SHORT-TERM MORTALITY IN SEPTIC PATIENTS: A RETROSPECTIVE STUDY BASED ON MIMIC-IV.

Objective: The aim of the study is to explore the impact of early serum phosphate levels on the prognosis of critically ill patients with sepsis. Methods: In this retrospective large cohort study, data of patients with sepsis were obtained from the Medical Information Mart for Intensive Care IV database. Patients were retrospectively divided into a control group and three study groups according to their daily serum phosphate levels within 2 days of intensive care unit (ICU) admission. A Cox regression model was used to evaluate the association between serum phosphate levels and 28-day morbidity. Results: This study included 9,691 patients diagnosed with sepsis. During the first 2 days of ICU admission, patients with hyperphosphatemia in either of the 2 days had higher 28-day mortality, while patients in the hypophosphatemia group had lower 28-day mortality (first day, 32.9% vs. 16.3%; second day, 36.3% vs. 14.7%). After adjusting for potential confounders, hyperphosphatemia was significantly associated with 28-day mortality; however, only hypophosphatemia on the second day was independently associated with reduced 28-day mortality. After stratification in the hypophosphatemia group, subgroup analysis showed that only the association between the mild hypophosphatemia group and 28-day mortality reached statistical significance (hazard ratio = 0.76, 95% CI = 0.65-0.89, P = 0.001). Conclusions: Mild hypophosphatemia might improve the short-term prognosis of patients with sepsis, and hyperphosphatemia is an independent risk factor for the outcomes of septic patients. After ICU admission, the serum phosphate levels on the second day had a better independent correlation with 28-day mortality, which prompted us to reconsider the optimal timing of phosphate evaluation.

Frequency and Risk Factors of Hypophosphatemia in Patients Admitted to Emergency Intensive Care Unit in Zagazig University Hospitals.

Inorganic phosphate is a major electrolyte that participates in many functional and integral processes in the human body. Low Pi levels may lead to multiple organ dysfunction. It is estimated to occur in 40-80% of intensive care unit (ICU) patients. However, it may be ignored during the initial evaluation in ICU. This prospective cross-sectional study included 500 adult ICU cases in two groups; a group with normal Pi levels and a group with hypophosphatemia. All admitted patients were subjected to full history taking, and clinical, laboratory, and radiological evaluation. Collected data were coded, processed, and analyzed using statistical package for social sciences (SPSS) software. Among 500 adult ICU patients; 56.8% had normal phosphate levels while the remaining 43.2% had low phosphate levels. Patients in the hypophosphatemia group were associated with a significantly higher Acute Physiological and Chronic Health Evaluation (APACHE II) score, a longer hospital and ICU stay, a higher incidence of mechanical ventilation use with a longer duration on it, and a significantly higher mortality rate. Risk factors for hypophosphatemia include a higher APACHE II score, longer stay in the hospital and ICU, a higher ratio of mechanical ventilation, and a higher mortality rate. El-Sayed Bsar AEM, El-Wakiel SAR, El-Harrisi MAH, Elshafei ASH. Frequency and Risk Factors of Hypophosphatemia in Patients Admitted to Emergency Intensive Care Unit in Zagazig University Hospitals. Indian J Crit Care Med 2023;27(4):277-282.

Lower mean phosphate independently predicts mortality in critically ill patients: Results from a prospective cohort study

PurposeTo evaluate lower mean phosphate as a prognostic tool in critically ill patients. MethodsThis is a prospective single-center cohort study including adult patients (> 18 years) with a length of intensive care unit (ICU) stay of at least 24 h. Phosphatemia was evaluated within 1 h of ICU admission and once daily. Mean phosphate, calculated by the simple arithmetic mean of daily phosphate measurements, was proposed and tested. Standard severity scores were applied. Multivariate and survival analyses were performed. ResultsA total of 317 patients were included, of whom 111 (35%) presented hypophosphatemia. Hypophosphatemia associated with surgical conditions, nutritional therapy, hypovitaminosis D, hyperparathyroidism, mechanical ventilation (need and duration), and ICU and hospital length of stay were evaluated. Admission APACHE II and SOFA (ICU days 1, 3, and 7) scores and ICU and in-hospital mortality were greater in the hypophosphatemia group than control group. Higher APACHE II (RR: 1.1; 95%CI: 1.01–1.2; p = 0.045) and lower mean phosphate (RR: 0.02; 95%CI: 0.001–0.09; p = 0.044) independently predicted ICU and in-hospital mortality. ConclusionsHypophosphatemia is frequent in the ICU, and was associated with unfavorable outcomes. This study introduces the importance of longitudinal monitoring of phosphate levels, since lower mean phosphate is an independent predictor of mortality in critically ill patients.

Effect of hypophosphatemia on prognosis after spontaneous intracerebral hemorrhage: a retrospective study.

Hypophosphatemia often occurs after spontaneous intracerebral hemorrhage, but the effect of hypophosphatemia on its prognosis is under debate. Clinical data of patients with spontaneous intracerebral hemorrhage admitted to our neurosurgery department from January 2018 to June 2020 were retrospectively analyzed. The patients were divided into the hypophosphatemia group and the nonhypophosphatemia group according to the serum phosphorus test values obtained three times within 1week after admission. The incidence of complications during hospitalization, 28-day mortality, and 6-month mRS score were compared between the two groups. The influence of low phosphorus in patients with hypophosphatemia on the 6-month mRS score was explored. A total of 133 patients were included, of which 85 had hypophosphatemia. Forty-two patients (21 in the hypophosphatemia group and 21 in the nonhypophosphatemia group) were enrolled after propensity score matching. There were no statistically significant differences in the incidence of complications during hospitalization, 28-day mortality, and 6-month mRS score between the two groups (P > 0.05). In 85 patients with hypophosphatemia, the minimum serumphosphorus was associated with the 6-month mRS score (B = - 3.153, 95% CI: - 5.842 ~ - 0.463, P = 0.022). The cutoff value of serumphosphorus for predicting 6-month mRS score was 0.505mmol/l. Whether hypophosphatemia occurred during hospitalization in patients with spontaneous intracerebral hemorrhage showed no effect on the incidence of complications, 28-day mortality, and 6-month mRS score. A significant decrease in serum phosphorus during hospitalization (≤ 0.505mmol/l) might correlate with a poor 6-month mRS score. Maintaining serum phosphorus stability after spontaneous intracerebral hemorrhage may improve prognosis.

Effect of hypophosphatemia on the prognosis of critically ill patients

To explore the impact of hypophosphatemia on the occurrence and prognosis of critically ill patient. The clinical data of critically ill patients admitted to the intensive care unit (ICU) of Tianjin First Central Hospital from October 2021 to April 2022 were retrospectively analyzed. Patients were divided into hypophosphatemia group (serum phosphorus level < 0.80 mmol/L) and non-hypophosphatemia group (serum phosphorus level ≥ 0.80 mmol/L) when they were admitted to the ICU. The following variables were also collected, including gender, age, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), serum phosphorus level, serum calcium level, serum magnesium level, white blood cell count (WBC), neutrophil count (NEU), lymphocyte count (LYM), neutrophil/lymphocyte ratio (NLR), C-reactive protein (CRP), presence of infection and infection site, length of hospital stay, ICU stay, 28-day mortality, and mechanical ventilation time. Multivariate Logistic regression analysis was used to evaluate the relationship between each variable and the 28-day mortality. The receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) and 95% confidence interval (95%CI) were calculated to evaluate the predictive value of serum phosphorus levels for the prognosis of ICU patients. A total of 263 patients were enrolled, including 54 patients with hypophosphatemia and 209 patients without. The SOFA score, LYM level and the infection rate of patients in the hypophosphatemia group were significantly higher than those in the non-hypophosphatemia group [SOFA score: 6.70±3.17 vs. 5.64±3.59, LYM (×109/L): 0.99±0.54 vs. 0.77±0.54, infection rate: 77.78% (42/54) vs. 59.33% (124/209), all P < 0.05], the NLR was significantly lower than that of the non-hypophosphatemia group [10.67 (7.08, 18.02) vs. 12.25 (7.25, 21.68), P < 0.05]. The length of hospital stay, ICU stay, and mechanical ventilation duration in the hypophosphatemia group were significantly longer than those in the non-hypophosphatemia group [length of hospital stay (days): 15 (11, 28) vs. 12 (6, 21), length of ICU stay (days): 10.35±7.80 vs. 7.15±6.61, mechanical ventilation duration (days): 3 (0, 12) vs. 2 (0, 5), all P < 0.05]. There was no significant difference in the 28-day mortality between the hypophosphatemia group and the non-hypophosphatemia group [9.26% (5/54) vs. 11.00% (23/209), P > 0.05]. Multivariate Logistic regression analysis showed that APACHE II score [odds ratio (OR) = 1.188, 95%CI was 1.110-1.271], CRP (OR = 1.016, 95%CI was 1.007-1.026), and NLR (OR = 1.002, 95%CI was 0.996-1.008) were independent risk factors affecting the 28-day mortality of critically ill patients in ICU (all P < 0.05). ROC curve analysis showed that the AUC of serum phosphorus levels for predicting the length of hospital stay of critically ill patients in ICU > 10 days, ICU stay > 5 days, and mechanical ventilation duration > 5 days were 0.701 (95%CI was 0.632-0.770), 0.771 (95%CI was 0.691-0.852), 0.617 (95%CI was 0.541-0.692), respectively, all P < 0.01. Hypophosphatemia has some predictive value for the length of hospital and ICU stay and mechanical ventilation time in critically ill patients, but it cannot predict the 28-day mortality.

Frequency of hypophosphatemia in critically ill children: risk factors and outcome

Background: Phosphorus plays a vital role in maintaining metabolism and energy of body. The objective of this study was to determine the frequency, risk factors and outcome of hypophosphatemia (HP) in critically ill children admitted in pediatric intensive care unit.Methods: This retrospective study included all critically-ill children having phosphate levels within 24 hours of admission from July 2019 to December 2020. Demographic, clinical and laboratory variables were collected. HP is defined as serum phosphorus level ≤4 mg/dl in this study. Descriptive statistics along with logistic regression analysis have been reported. Results: Prevalence of HP was 53.7% (94/175). Median age was 2 year (0.5-15) and male were 58.5% (106). Serum magnesium level [2.2 (1.5-12.1) vs. 1.8 (1.2-4.0) mg/dl] and serum calcium level [8.7 (.18-10.7) 8.0 (1.8-14.0) mg/dl] were significantly low in the HP group as compared to the normo-phosphatemic group. There was no significant association of hypo-phosphataemia with admitting diagnosis, ICU therapies, and medications on univariate analysis. Hypo-phosphataemia at admission had no effect on mortality. On multivariate analysis, only male gender demonstrated independent association with HP (OR: 2.2; 95% CI 1.2-4.1; p&lt;0.01).Conclusions: HP is common in critically ill children and is significantly associated with male gender. Prospective, larger sample size studies are needed to study the prevalence and risk factors of HP at pediatric intensive care units.

Monthly triple-dose gadolinium administration: potential associations with leukopenia, hypophosphatemia, and bone marrow T1 hyperintensity.

ObjectiveMonthly scanning with triple-dose gadopentetate dimeglumine has been shown to be associated with progressive increases in bone T1 hyperintensity, hypophosphatemia, and leukopenia. This study was performed to retrospectively investigate the potential associations among these phenomena.MethodsThis retrospective analysis involved patients who had received monthly triple-dose gadopentetate dimeglumine for up to 2 years as part of treatment for multiple sclerosis. Monthly magnetic resonance imaging scans of the brain (n = 67) were segmented to evaluate the signal intensity in the cranial marrow. Potential associations among the marrow T1 hyperintensity, serum phosphate concentration, and white blood cell count were examined.ResultsPatients in the no leukopenia group showed a statistically significant mean monthly increase in the bone marrow signal-to-noise ratio of 0.0430/month. Patients in the leukopenia group showed a mean monthly increase in the bone marrow signal-to-noise ratio of 0.0398/month, but this was not statistically significant. Patients in the hypophosphatemia group were significantly less likely to develop leukopenia than patients who had never developed hypophosphatemia.ConclusionsAlthough monthly administration of triple-dose gadopentetate dimeglumine over 13 months has been associated with progressive increases in leukopenia, hypophosphatemia, and T1 signal intensity of bone, this study showed an inverse relationship between leukopenia and hypophosphatemia.

POS-748 HYPOPHOSPHATEMIA AFTER KIDNEY TRANSPLANTATION IN CHILDREN: A RETROSPECTIVE SINGLE CENTER EXPERIENCE

Hypophosphatemia is among the common complications that are seen after kidney Transplantation (KTX). It’s noticed in the first few days in most of the KTX, particularly a well-functioning graft, and its tretment may continued many months after KTX in certain conditions. Our aim is to identify hypophosphatemia after KTX, as well its potential association with Parathyroid hormone and Vitamin D. A retrospective study of children underwent KTX between 2009-2021. We collected their Baseline demographics, type of KTX, their primary kidney diseases, time after KTX of first presentation of hypophosphatemia, initial serum phosphate level, initial levels of Parathyroid hormone, 25 OH vitamin D, Calcium, and Magnesium, time of its resolution after KTX. A 38 children underwent KTX between 2009 and 2021, their baseline demographics are shown in Table 1. A 26 (68%) of children developed hypophosphatemia with a mean of occurrence at 5 days after KTX, and range of 1 to 12 days. Early (within three days) drops in serum phosphate have been found more in living KTX, which have related to immediate functioning of the allograft, and tend to be more severe, while delayed ( more than 6 days) drops are seen more with deceased KTX, as its more likely to be associated with relative delay in graft function. The average serum phosphate level in hypophosphatemia group was 0.6 mmol/l with a range of 0.28 to 0.8 mmol/l. The mean duration of requirement of phosphate supplement after KTX was 6 months days with a range of 0.5 to 39 months. All the patients were managed with oral phosphate with a mean of dose of 650 mg/day and range of 250 mg/ day to 1500 mg/day, without the requirement of intravenous supplement except in four patients from living KTX group. The associated levels of serum Phosphate, serum Calcium, serum Magnesium, 25 OH vitamin D, and PTH for both hypophosphatemic group and normal phosphate group are shown in table 2 and 3 respectively. Children with hypophosphatemia tend to have a higher mean PTH and 25(OH)2 Vitamin D level, but the difference is not statistically significant. Table 1: Baseline Demographics Tabled 1VariableValueAge at TransplantationMean 8 yearsGenderMale 22 (58 %)Weight (Kg)22Deceased donor26 (68%)Live Related donor9 (24%)Live unrelated donor3 (8%)HLA mismatches4/6Causes of Chronic kidney diseaseCAKUT16(42%)FSGS10 (26%)CNS4 (10 %)Nephronophthesis2 (6%)Nephropathic cystinosis1 (3%)ARPKD1 (3%)Unknown4 (8%) Open table in a new tab Table 2: Hypophosphatemia group Tabled 1VariableMean (range)Phosphate (mmol/l)0.6 (0.28-0.8)Calcium (mmol/l)2.22 (1.91- 2.63)Magnesium (mmol/l)0.73 (0.52- 1.17)Alkaline Phosphatase (U/l)194 ( 51- 713)Parathyroid Hormone (Pg/ml)587 (34 - 1565)25 (OH)2 Vitamin D (nmol/l)53 ( 7- 110) Open table in a new tab Table 3: Normophosphatemia group Tabled 1VariableMean (range)Phosphate (mmol/l)1.22 (0.9-1.64)Calcium (mmol/l)2.30 (2.15- 2.78)Magnesium (mmol/l)0.75 (0.55- 1.03)Alkaline Phosphatase (U/l)176 ( 55- 297)Parathyroid Hormone (Pg/ml)520 (113 - 1354)25 (OH)2 Vitamin D (nmol/l)43 ( 7- 82) Open table in a new tab Hypophosphatemia is a commonly seen after kidney transplantation particularly those with immediately functioning graft, higher PTH is a known potential contributory factor but that was observed partly in our cohort. our result should be interpreted with caution because of small sample size and retrospective design, so prospective large sample study can delineate this area more clearly.

Hypophosphatemia at Admission is Associated with Increased Mortality in COVID-19 Patients.

BackgroundElectrolyte disturbances are commonly observed in patients with coronavirus disease 2019 (COVID-19) and associated with outcome in these patients. Our study was designed to examine whether hypophosphatemia is associated with mortality in COVID-19 patients.MethodsPatients diagnosed with COVID-19 and hospitalized in Renmin Hospital of Wuhan University between January 30 and February 24, 2020 were included in this study. Patients were divided into two groups, a hypophosphatemia group and a non-hypophosphatemia group, based on a serum phosphate level of 0.8 mmol/L. Logistic regression was performed to analyze the relationship between hypophosphatemia and mortality. A locally weighted scatterplot smoothing (LOWESS) curve was plotted to show the detailed association between mortality rate and serum phosphate level. A Kaplan–Meier survival curve was drawn to compare the difference in cumulative survival between the two groups.ResultsHypophosphatemia at admission occurred in 33 patients, with an incidence of 7.6%. The hypophosphatemia group had a significantly higher incidence of respiratory failure (54.5% vs 32.6%, p=0.013) and mortality (57.6% vs 15.2%, p<0.001). Multivariate logistic regression indicated that age (OR=1.059, p<0.001), oxygen saturation (OR=0.733, p<0.001), white blood cells (OR=1.428, p<0.001), lymphocytes (OR=0.075, p<0.001) and hypophosphatemia (OR=3.636, p=0.015) were independently associated with mortality in the included patients. The hypophosphatemia group had significantly shorter survival than the non-hypophosphatemia group (p<0.001).ConclusionHypophosphatemia at admission is associated with increased mortality in COVID-19 patients. More attention and medical care should be given to COVID-19 patients with hypophosphatemia at admission.

Impact of hypophosphatemia on weaning from mechanical ventilation

To explore the influence of hypophosphatemia on weaning from mechanical ventilation. An observational study was conducted. The medical records of 30 mechanical ventilated patients with hypophosphatemia admitted to intensive care unit of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2018 to August 2020 were analyzed; another 60 mechanical ventilated patients with normophosphatemia around the same time were enrolled as controls by 1:2 case-control matching based on gender, age, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score. And then the duration of invasive mechanical ventilation, times of spontaneous breathing trial (SBT), the diaphragmatic ultrasonography movement indexes, and outcome of weaning and prognosis during hospitalization were compared between the two groups. Receiver operator characteristic curve (ROC curve) was plotted to calculate the areas under ROC curve (AUC) and cut-off values of serum phosphorus for successful weaning and hospital survival. The correlations between the diaphragmatic ultrasonography movement indexes and serum phosphorus were analyzed by Pearson partial correlation analysis. Compared with normophosphatemic group, the duration of invasive mechanical ventilation in hypophosphatemia group was significantly longer [days: 13.0 (7.0, 22.0) vs. 10.0 (5.5, 14.0), P < 0.05], and SBT attempts were more often [times: 3 (0, 5) vs. 1 (1, 2), P < 0.01], while the rate of successful weaning was lower (53.3% vs. 91.7%, P < 0.01), and the hospital mortality was higher (20.0% vs. 1.7%, P < 0.01). ROC curve analysis showed that serum phosphorus could predict successful weaning of mechanical ventilated patients, the AUC was 0.795, and the optimum cut-off value of serum phosphorus was 0.85 mmol/L with sensitivity of 73.2% and specificity of 84.2%. Serum phosphorus could predict hospital survival of mechanical ventilated patients, the AUC was 0.782, and the optimum cut-off value of serum phosphorus was 0.48 mmol/L with sensitivity of 81.9% and specificity of 85.7%. Compared with normophosphatemic group, diaphragm thickness at the end of inspiration (DTei), diaphragm thickness at the end of expiration (DTee), diaphragm thickening fraction (DTF), diaphragm excursion (DE) in hypophosphatemia group were all significantly decreased [DTei (cm): 0.19±0.07 vs. 0.27±0.08, DTee (cm): 0.14±0.05 vs. 0.19±0.06, DTF: (33.55±16.17)% vs. (45.04±18.66)%, DE (cm): 1.17±0.49 vs. 2.28±0.69, all P < 0.01]. Pearson partial correlation analysis showed that linear correlations were found between serum phosphorus and DTei, DTee, DTF, DE (r values were 0.442, 0.351, 0.293, 0.628 respectively, all P < 0.01). Serum phosphorus may have correlation with the diaphragmatic ultrasonography movement indexes. Hypophosphatemia may impair the contractile properties of diaphragm, induce more SBT attempts and longer duration of invasive mechanical ventilation, and affect outcome of weaning and prognosis.

Phosphate Disturbance in Critically Ill Children in Zagazig University Pediatric Intensive Care Unit

Background: Phosphorus is very important for normal cellular structure (cell membrane and nucleic acids). Phosphorus has an important role in the cell metabolism, ATP production, and homeostasis. Objectives: The aim of the work was to determine the prevalence and some of risk factors of hypophosphatemia in sick children, and to evaluate the prognostic effect of serum phosphorous level on the outcome in terms of morbidity and mortality in critically ill children during their stay in the pediatric intensive care unit. Patients and methods: This prospective cohort study included a total of 50 critically ill children, attending at Department of Biochemistry and Pediatric Intensive Care Unit (PICU), Department of Pediatrics, Zagazig University Hospitals. This study was conducted between April 2017 to August 2018. Patients age ranged from 2 months to 129 months and according to serum phosphorus level cases were classified into those with hypophosphatemia and others with normal phosphate level. The severity of illness was determined by using SOFA score. Results: Revealed that there was statistically significant decrease in phosphorus level at day 1 and day 3 between hypophosphatemia and normal phosphate level groups. The prevalence of hypophosphatemia was 46% at first day of admission and 70% at third day of admission. Significant increase of PTH and total bilirubin in hypophosphatemia group, and significant decrease of calcium in hypophosphatemia group compared to normophosphatemia group. The cases were followed and compared regarding; morbidity (need for mechanical ventilation, and length of PICU stay), degree of organ failure (SOFA score) and their outcome (discharge from PICU or death). Conclusion: It could be concluded that hypophosphatemia is considered a common co-morbidity in critically ill children in PICU. Hypophosphatemia more prevalent in those with respiratory problems, and higher SOFA score.

Impact of hypophosphatemia on outcome of patients in intensive care unit: a retrospective cohort study

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.

Hypophosphatemia Regulates Molecular Mechanisms of Circadian Rhythm

Transcriptomic analysis showed that the central circadian pathway genes had significantly altered expression in fracture calluses from mice fed a low phosphate diet. This led us to hypothesize that phosphate deficiency altered the circadian cycle in peripheral tissues. Analysis of the expression of the central clock genes over a 24–36 hour period in multiple peripheral tissues including fracture callus, proximal tibia growth plate and cardiac tissues after 12 days on a low phosphate diet showed higher levels of gene expression in the hypophosphatemia groups (p < 0.001) and a 3 to 6 hour elongation of the circadian cycle. A comparative analysis of the callus tissue transcriptome genes that were differentially regulated by hypophosphatemia with published data for the genes in bone that are diurnally regulated identified 1879 genes with overlapping differential regulation, which were shown by ontology assessment to be associated with oxidative metabolism and apoptosis. Network analysis of the central circadian pathway genes linked their expression to the up regulated expression of the histone methyltransferase gene EZH2, a gene that when mutated in both humans and mice controls overall skeletal growth. These data suggest that phosphate is an essential metabolite that controls circadian function in both skeletal and non skeletal peripheral tissues and associates its levels with the overall oxidative metabolism and skeletal growth of animals.

Hypophosphatemia as a sign of malnutrition in older hospitalized patients

The relationship between hypophosphatemia (HP) and malnutrition in older hospitalized patients has received little attention. We sought to investigate this association among this population. The study participants were consecutively admitted to a geriatric acute care ward in six hospitals. Malnutrition screening was conducted by Mini Nutritional Assessment-Short Form. Patients were divided into two groups according to serum phosphate: HP (<0.68 mmol/l) and non-HP groups (>0.68 mmol/l). Of 335 participants, 7% of subjects had HP. Malnutrition or nutritional risk was present in 86 and 56% of participants with and without HP, respectively (P = 0.003). The analysis indicated 9.8, 86.4, 97.9 and 44.0% sensitivity, positive predictive value, specificity and negative predictive value of HP with regard to malnutrition, respectively. This study demonstrated that HP in older hospitalized patients is associated with malnutrition and may be used as an indicator of nutritional risk. Contrary, normal serum phosphate does not exclude being at nutritional risk.

Late and Insufficient Phosphorus Supplementation is Associated with Early Severe Hypophosphatemia in Extremely Low Birth Weight Infants with Early Amino Acid Administration

Objective: To investigate the incidence of early severe hypophosphatemia, and examine the associated clinical factors and outcomes, in extremely low birth weight infants (ELBWI) who received early amino acid administration. Methods: Medical records of 82 ELBWI were retrospectively reviewed. Severe hypophosphatemia was defined as a serum phosphate level <2 mg/dL during the first week after birth. Results: Nineteen ELBWI (23.2%) experienced severe hypophosphatemia. The supplementation of phosphorus was started significantly later in the hypophosphatemia group compared to that in the control group (P=0.036). Small for gestational age infants (SGAI) (P=0.006) and bronchopulmonary dysplasia (P=0.016) were more prevalent in the hypophosphatemia group compared to that in the control group. Conclusion: Early severe hypophosphatemia is common in ELBWI. Late and insufficient supplementation of phosphorus and SGAI were associated with severe hypophosphatemia.

Effect of hypophosphatemia on the withdrawal of mechanical ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease.

Mechanical ventilation (MV) is a life-supporting modality frequently performed in critically ill patients to mechanically assist or replace spontaneous breathing. The aim of this study was to investigate the effect of hypophosphatemia on the withdrawal of MV in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The medical records of 67 AECOPD cases, treated with MV between 2011 and 2013, were analyzed retrospectively. The patients were assigned to the hypophosphatemic and the normophosphatemic groups according to their serum phosphate levels (with the threshold of 0.87 mmol/l). The results showed that the morbidity rate of hypophosphatemia in these AECOPD patients was 56.72%. A significantly higher percentage of failure-to-wean from MV was observed in the hypophosphatemia group vs. the normophosphatemic group (34.21 vs. 10.34%, P<0.05). Furthermore, hypophosphatemia was associated with respiratory muscular weakness, as reflected by a decrease in the tidal volume of spontaneous respiration, reduced static lung compliance and impaired pulmonary function, leading to weaning failure. The findings suggested that hypophosphatemia significantly affected the weaning from MV in AECOPD patients. Serum phosphorus levels may therefore serve as a reference index to determine the success of weaning.