Associations between Phosphate Concentrations and Hospital Mortality in Critically Ill Patients Receiving Mechanical Ventilation

Beong Ki Kim; Chi Young Kim; Sua Kim; Yu Jin Kim; Seung Heon Lee; Je Hyeong Kim

doi:10.3390/jcm11071897

journal article Open Access Mar 29, 2022

Associations between Phosphate Concentrations and Hospital Mortality in Critically Ill Patients Receiving Mechanical Ventilation

Beong Ki Kim

Chi Young Kim Sua Kim

Yu Jin Kim

Seung Heon Lee

Je Hyeong Kim

Journal of Clinical Medicine Vol. 11 No. 7 pp. 1897 · MDPI AG

View at Publisher Save 10.3390/jcm11071897

Abstract

Phosphate concentrations change continuously throughout hospitalization; however, it is unclear which available phosphate measures are most clinically important for predicting hospital mortality. Therefore, we investigated phosphate concentrations in association with hospital mortality following admission to the intensive care unit. We retrospectively enrolled all adult patients receiving mechanical ventilation. Phosphate concentrations were divided into three categories: initially measured phosphate (iP); maximum–minimum phosphate values (ΔP); and phosphate arithmetic average (Pmean). In total, 175 patients were enrolled. The hospital mortality rate was 32.6%, and the most common primary diagnosis was respiratory failure. In multivariable logistic regression analyses, the odds ratios for hospital mortality in association with ΔP and Pmean values were 1.56 and 2.13, respectively (p < 0.0001). According to the obtained receiver operating characteristic curve, ΔP (0.75) and Pmean (0.72) each showed a fair predictive power for hospital mortality. In evaluating relative risks, we found that higher concentrations of Pmean and ΔP were each associated with a higher hospital mortality. ΔP and Pmean values were significantly associated with hospital mortality in critically ill patients, compared to iP. These findings showed that throughout hospitalization, it is important to reduce phosphate level fluctuations and maintain appropriate phosphate concentrations through consistent monitoring and corrections.

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References

31

[1]

Baker "The essentials of calcium, magnesium and phosphate metabolism: Part I. Physiology" Crit. Care Resusc. (2002)

[2]

Wadsworth "Phosphate homeostasis in critical care" BJA Educ. (2016) 10.1093/bjaed/mkw033

[3]

Thongprayoon "Admission hyperphosphatemia increases the risk of acute kidney injury in hospitalized patients" J. Nephrol. (2018) 10.1007/s40620-017-0442-6

[4]

Hypophosphatemia in critically ill patients

Satoshi Suzuki, Moritoki Egi, Antoine G. Schneider et al.

Journal of Critical Care 2013 10.1016/j.jcrc.2012.10.011

[5]

Fiaccadori "Hypophosphatemia and phosphorus depletion in respiratory and peripheral muscles of patients with respiratory failure due to COPD" Chest (1994) 10.1378/chest.105.5.1392

[6]

Schwartz "Association between hypophosphatemia and cardiac arrhythmias in the early stages of sepsis" Eur. J. Intern. Med. (2002) 10.1016/s0953-6205(02)00130-9

[7]

Han "Severe hypophosphatemia-induced acute toxic-metabolic encephalopathy in continuous renal replacement therapy" Electrolyte Blood Press. (2019) 10.5049/ebp.2019.17.2.62

[8]

Berner "Consequences of phosphate imbalance" Annu. Rev. Nutr. (1988) 10.1146/annurev.nu.08.070188.001005

[9]

Gravelyn "Hypophosphatemia-associated respiratory muscle weakness in a general inpatient population" Am. J. Med. (1988) 10.1016/0002-9343(88)90065-4

[10]

Aubier "Effect of hypophosphatemia on diaphragmatic contractility in patients with acute respiratory failure" N. Engl. J. Med. (1985) 10.1056/nejm198508153130705

[11]

Alsumrain "Association of hypophosphatemia with failure-to-wean from mechanical ventilation" Ann. Clin. Lab. Sci. (2010)

[12]

Thongprayoon "Admission serum phosphate levels and the risk of respiratory failure" Int. J. Clin. Pract. (2020) 10.1111/ijcp.13461

[13]

Hypophosphatemia on ICU Admission Is Associated with an Increased Length of Stay in the ICU and Time under Mechanical Ventilation

Hannah Wozniak, André Dos Santos Rocha, Tal Sarah Beckmann et al.

Journal of Clinical Medicine 10.3390/jcm11030581

[14]

Hypophosphatemia during continuous hemodialysis is associated with prolonged respiratory failure in patients with acute kidney injury

S. Demirjian, B. W. Teo, J. A. Guzman et al.

Nephrology Dialysis Transplantation 2011 10.1093/ndt/gfr075

[15]

Shah "Hypophosphatemia in critically ill children: Risk factors, outcome and mechanism" Indian J. Pediatr. (2016) 10.1007/s12098-016-2188-x

[16]

Haider, D.G., Lindner, G., Wolzt, M., Ahmad, S.S., Sauter, T., Leichtle, A.B., Fiedler, G.M., Fuhrmann, V., and Exadaktylos, A.K. (2015). Hyperphosphatemia is an independent risk factor for mortality in critically ill patients: Results from a cross-sectional study. PLoS ONE, 10. 10.1371/journal.pone.0133426

[17]

Wang, L., Xiao, C., Chen, L., Zhang, X., and Kou, Q. (2019). Impact of hypophosphatemia on outcome of patients in intensive care unit: A retrospective cohort study. BMC Anesthesiol., 19. 10.1186/s12871-019-0746-2

[18]

Miller "Impact of serum phosphate in mechanically ventilated patients with severe sepsis and septic shock" J. Intensive Care Med. (2020) 10.1177/0885066618762753

[19]

Cheungpasitporn "Admission serum phosphate levels predict hospital mortality" Hosp. Pract. (2018) 10.1080/21548331.2018.1483172

[20]

Hedjoudje "Serum phosphate is associated with mortality among patients admitted to ICU for acute pancreatitis" United Eur. Gastroenterol. J. (2021) 10.1002/ueg2.12059

[21]

Phosphate abnormalities and outcomes among admissions to the intensive care unit: A retrospective multicentre cohort study

Jeremy Cheuk Kin Sin, Kevin B. Laupland, Mahesh Ramanan et al.

Journal of Critical Care 2021 10.1016/j.jcrc.2021.03.012

[22]

Thongprayoon, C., Cheungpasitporn, W., Hansrivijit, P., Thirunavukkarasu, S., Chewcharat, A., Medaura, J., Mao, M.A., and Kashani, K.B. (2020). Impact of serum phosphate changes on in-hospital mortality. BMC Nephrol., 21. 10.1186/s12882-020-02090-3

[23]

Eddington "Serum phosphate and mortality in patients with chronic kidney disease" Clin. J. Am. Soc. Nephrol. (2010) 10.2215/cjn.00810110

[24]

Kestenbaum "Serum phosphate levels and mortality risk among people with chronic kidney disease" J. Am. Soc. Nephrol. (2005) 10.1681/asn.2004070602

[25]

Hamano "Serum phosphate level and the prognosis of dialysis patients" Clin. Calcium (2009)

[26]

Ess "Serum phosphate and long-term outcome among patients with stable heart failure" J. Card. Fail. (2013) 10.1016/j.cardfail.2012.11.008

[27]

Sato, M., Kataoka, H., Ushio, Y., Manabe, S., Watanabe, S., Akihisa, T., Makabe, S., Yoshida, R., Iwasa, N., and Mitobe, M. (2020). High serum phosphate level as a risk factor to determine renal prognosis in autosomal dominant polycystic kidney disease: A retrospective study. Medicines, 7. 10.3390/medicines7030013

[28]

Tao "Effect of the concentration of serum phosphate on the prognosis of patients with sepsis" Chin. J. Clin. Health (2008)

[29]

Geerse "Approach to hypophosphataemia in intensive care units—A nationwide survey" Neth. J. Med. (2012)

[30]

Charron "Intravenous phosphate in the intensive care unit: More aggressive repletion regimens for moderate and severe hypophosphatemia" Intensive Care Med. (2003) 10.1007/s00134-003-1872-2

[31]

Bech "Hypophosphatemia on the intensive care unit: Individualized phosphate replacement based on serum levels and distribution volume" J. Crit. Care (2013) 10.1016/j.jcrc.2013.03.002

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Details

Published: Mar 29, 2022
Vol/Issue: 11(7)
Pages: 1897
License: View

Authors

B

Beong Ki Kim

Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan 15355, Korea

C

Chi Young Kim

Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan 15355, Korea

S

Sua Kim

Department of Critical Care Medicine, Korea University Ansan Hospital, Ansan 15355, Korea

Y

Yu Jin Kim

Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan 15355, Korea

S

Seung Heon Lee

Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan 15355, Korea

J

Je Hyeong Kim

Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan 15355, Korea; Department of Critical Care Medicine, Korea University Ansan Hospital, Ansan 15355, Korea

Cite This Article

Beong Ki Kim, Chi Young Kim, Sua Kim, et al. (2022). Associations between Phosphate Concentrations and Hospital Mortality in Critically Ill Patients Receiving Mechanical Ventilation. Journal of Clinical Medicine, 11(7), 1897. https://doi.org/10.3390/jcm11071897

Associations between Phosphate Concentrations and Hospital Mortality in Critically Ill Patients Receiving Mechanical Ventilation

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