Epidemiology of hypophosphatemia in critical illness: A multicentre, retrospective cohort study - 28/09/24
, Kyle C White c, d, Ra'eesa Doola d, e, f, Philippa McIlroy g, Siva Senthuran h, i, Stephen Luke j, Peter Garrett k, l, Alexis Tabah d, m, n, Kiran Shekar d, o, Felicity Edwards n, p, Hayden White l, q, James PA McCullough r, Rod Hurford c, Pierre Clement p, Kevin B Laupland n, p, Mahesh Ramanan d, o, s, ton behalf of Queensland Critical Care Research Network (QCCRN)1
Graphical abstract |
Highlights/Take Home Message |
• | Mild hypophosphatemia (Serum PO4 ≥ 0.5–<0.81 mmol/L) is common in ICU patients with a peak onset on Day 2 of ICU admission, with subsequent rapid correction over 2–3 days. |
• | Substantial variations among sites in dose, route, threshold for administration, and duration of phosphate replacement were noted. |
• | Most hypophosphatemic patients spent between 25%–50% of their ICU admissions days with low serum phosphate concentrations. |
• | Patients with moderate (odds ratio (OR) 1.24; 95% confidence intervals (CI) 1.07–1.44; p = 0.004) or severe (OR 1.49; 95% CI 1.13–1.97; p = 0.005) hypophosphatemia had increased risk of 90-day case fatality when compared to patients without hypophosphatemia. |
Abstract |
Introduction |
Hypophosphatemia is common in critically ill patients. We have described the epidemiology of hypophosphatemia in patients admitted to the Intensive Care Units.
Methods |
A multicentre, retrospective cohort study of 12 ICUs in Queensland, Australia from January 1st, 2015, to December 31st, 2021. Exclusions included readmissions, renal replacement therapy, end-stage renal disease, and palliative intent admissions and transfers from other ICUs. Patients were classified into four groups based on the severity of the first episode of low serum phosphate (PO4): “None” (PO4: ≥0.81 mmol/L, “Mild” (PO4: ≥0.50 & <0.81 mmol/L) “Moderate” (PO4: ≥0.30 & <0.50 mmol/L) and “Severe” (PO4: <0.30 mmol/L). A mixed-effect logistic regression model, including hospital as a random effect, was developed to examine factors associated with 90-day case fatality.
Results |
Of the 89,776 patients admitted, 68,699 patients were included in this study, with 23,485 (34.2%) having hypophosphatemia with onset mostly on Day 2 of ICU admission and correcting to normal 3 days after hypophosphatemia was identified. There was substantial variation among participating ICUs in phosphate replacement; the threshold, and the route by which it was replaced. Day-90 case fatality increased with severity of hypophosphatemia (None: 3974 (8.8%), Mild: 2306 (11%), Moderate: 377 (14%); Severe: 108 (21%) (p < 0.001)). Multivariable regression analysis showed that compared to those without hypophosphatemia, patients with moderate (odds ratio (OR) 1.24; 95% confidence intervals (CI) 1.07–1.44; p = 0.004) or severe (OR 1.49; 95% CI 1.13–1.97; p = 0.005) hypophosphatemia had increased risk of 90-day case fatality.
Conclusion |
Hypophosphatemia was common, and mostly occurred on day 2 with early correction of serum phosphate. Phosphate replacement practices were variable among ICUs. Moderate and severe hypophosphatemia was associated with increased 90-day case fatality.
Le texte complet de cet article est disponible en PDF.Keywords : Critical illness, Electrolyte imbalance, Hypophosphatemia, Multicentre, Phosphate replacement
Plan
Vol 43 - N° 5
Article 101410- octobre 2024 Retour au numéro
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