Hypophosphatemia and recovery of post-hepatectomy liver insufficiency

Hallet, Julie; Karanicolas, Paul J.; Zih, Francis Si Wai; Cheng, Emily YiQin; Wong, Jau Min; Hanna, Sherif S.; Coburn, Natalie; Law, Calvin

doi:10.21037/hbsn.2015.12.13

Cited by 15 publications

(30 citation statements)

References 30 publications

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“…36 Hypophosphatemia is common following hepatic resection and more thoroughly studied. 34,35 Given that hypophosphatemia may be associated with improved outcomes after hepatectomy and worse outcomes after pancreatectomy, it has been postulated that the underlying mechanism for hypophosphatemia may be different following hepatectomy than for pancreatectomy. 38,39 Many explanations have been proposed to explain hepatic surgery-related hypophosphatemia, including liver regeneration resulting in rapid consumption of serum phosphate, although evidence suggests that the rate of liver mass recovery cannot mathematically account for the commonly observed degree of hypophosphatemia.…”

Section: Discussionmentioning

confidence: 99%

“…Hypophosphatemia following hepatectomy has been associated with decreased morbidity and mortality. 34,35 However, there is recent evidence that hypophosphatemia following pancreatectomy may be associated with increased morbidity, including the development of POPF. 36 We aimed to evaluate the relationship between early postoperative hypophosphatemia and POPF formation using a large, prospectively-maintained, institutional database.…”

Section: Introductionmentioning

confidence: 99%

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Lower phosphate levels following pancreatectomy is associated with postoperative pancreatic fistula formation

Mueller

Chang

Castillo

et al. 2019

HPB

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Background: Whereas hypophosphatemia following hepatectomy is associated with decreased morbidity, hypophosphatemia following pancreatectomy may be associated with increased morbidity, including the development of postoperative pancreatic fistula (POPF). This study aimed to evaluate the relationship between postoperative hypophosphatemia and POPF formation. Methods: Patients from our institutional Research Patient Data Registry who underwent pancreatectomy from 2001 to 2017 were included. POPF was defined according to the International Study Group for Pancreatic Fistulas (ISGPF) criteria and according to internal criteria for drain removal. Postoperative serum phosphate levels, demographics, and comorbidities were evaluated. Unadjusted and adjusted analyses were performed.Results: 2342 patients underwent pancreatic resection. Mean age was 63.0 years (SD 14.3), 51.2% were male, and 58.7% had pancreatic cancer. Of all resections, 67.7% were pancreaticoduodenectomies. In unadjusted analysis, phosphate levels were significantly and persistently lower on POD 0 and POD 2-5 in patients who developed POPF's. In adjusted analysis, POD 2 phosphate <1.75 predicted an additional 46% increased odds of POPF (OR 1.46 95% CI 1.06-2.01; p = 0.02). Distal pancreatectomy was independently associated with POPF formation when compared to pancreaticoduodenectomy (OR 1.72 95% CI 1.18-2.51; p = 0.005). Conclusion:Lower phosphate levels in the early post-operative period following both proximal and distal pancreatectomies is associated with increased risk of POPF.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lower phosphate levels following pancreatectomy is associated with postoperative pancreatic fistula formation

Mueller

Chang

Castillo

et al. 2019

HPB

View full text Add to dashboard Cite

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“…Animal models of radiolabeled phosphate in regeneration of liver tissues have confirmed such an assumption. 12 As such, serum phosphate levels have been added to prediction tools for recovery. 13 The mechanisms driving hepatic regeneration after acetaminophen-induced hepatotoxicity have not been fully elucidated, however, a doseresponse relationship is probable.…”

Section: Discussionmentioning

confidence: 99%

Aggressive Treatment of Life-Threatening Hypophosphatemia During Recovery From Fulminant Hepatic Failure: A Case Report

Bissell

Davis

Flannery

et al. 2017

J Intensive Care Med

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Acute liver failure secondary to acetaminophen overdose can be a life-threatening condition, characterized by severe electrolyte derangements. Hepatocyte regeneration is associated with phosphorous utilization and is a known complication of liver recovery following injury. We report the case of profound, life-threatening hypophosphatemia following recovery from acute fulminant liver failure. As the liver enzymes normalized, serum phosphorous levels plummeted. Our patient required an aggressive, individualized phosphorus replacement regimen, which resulted in a continuous infusion of intravenous (IV) sodium phosphate, titrated to a maximum rate of 30 mmol/h or 0.5 mmol/kg/h. The patient required over 400 mmol of total IV and oral phosphorous over the course of 48 hours. An aggressive approach to phosphorous replacement was done safely and effectively. Traditional replacement protocols are not adequate to sustain patients with this degree of hypophosphatemia. This is the first report to utilize a continuous infusion of phosphate with a maximum reported rate (0.5 mmol/kg/h). Our report summarizes a novel and safe approach for clinicians to maximally support these patients through high-dose, continuous infusion phosphorous administration.

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“…[ 19 , 20 ] Among patients undergoing hepatectomy, decreased phosphate level is a predictor of better survival and liver function recovery. [ 21 – 23 ] The results of previous studies with respect to hypophosphatemia in predicting outcomes of burn patients are also controversial. [ 24 – 26 ] However, hyperphosphatemia is less frequently addressed.…”

Section: Introductionmentioning

confidence: 99%

Hyperphosphatemia is associated with high mortality in severe burns

et al. 2018

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IntroductionPhosphate level is often deranged during acute illness, regardless of the presence of kidney injury or not. A few studies described that hypophosphatemia may associated with outcome in patients admitted to the burn unit, but the literatures for hyperphosphatemia is limited. Our study aims to evaluate if hyperphosphatemia, one of the sign of severe tissue damage or kidney injury, will associate with mortality of patients with severe burns.Materials and methodsThe study was a post hoc analysis of prospectively collected data from patients admitted to the burn unit between September 2006 and December 2011. Patients were stratified into normophosphatemic or hyperphosphatemic group by baseline plasma phosphate level. The primary endpoint is 90-day mortality.ResultsTotal 301 patients were included (hyperphosphatemia: n = 52; normophosphatemia: n = 249). The hyperphosphatemic group had lower Glasgow Coma Scale, mean arterial blood pressure, hemoglobin level, albumin, and higher TBSA of burns, APACHE II score, ABSI score, Acute kidney injury (AKI), and creatinine. The 90-day mortality was higher in the hyperphosphatemic group than in the normal group (53.8% vs 18.1%, P < .001) and this difference was still significant when adjusting for several confounding factors (hazard ratio, 2.05; 95% CI, 1.17–3.59). Multivariable Cox analysis showed risk factors of mortality included TBSA of burns, hyperphosphatemia, reduced urine output, and APACHE II score.ConclusionsOur study found in addition to TBSA of burns and inhalation injury, baseline hyperphosphatemia in patients with severe burns is also associated with higher mortality.

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Hypophosphatemia and recovery of post-hepatectomy liver insufficiency

Cited by 15 publications

References 30 publications

Lower phosphate levels following pancreatectomy is associated with postoperative pancreatic fistula formation

Lower phosphate levels following pancreatectomy is associated with postoperative pancreatic fistula formation

Aggressive Treatment of Life-Threatening Hypophosphatemia During Recovery From Fulminant Hepatic Failure: A Case Report

Hyperphosphatemia is associated with high mortality in severe burns

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