The relationship and threshold of serum phosphate with regard to the 28-day mortality risk in sepsis patients undergoing continuous renal replacement therapy

Abstract

Objective: To investigate the association between serum phosphate levels and the risk of 28-day mortality in critically-ill patients with septic acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT). Methods: This retrospective cohort study analysed data from critically-ill patients with septic AKI who underwent CRRT between January 2009 and September 2016. Demographic, clinical and routine biochemical data were retrieved from a database and analysed to identify risk factors for 28-day mortality. Results: A total of 796 patients were included in the analyses. Multivariate regression analyses showed that phosphate (0 h), phosphate (24 h) and delta phosphate were associated with the 28-day mortality in patients with septic AKI undergoing CRRT. The adjusted odds ratios (95% confidence interval) were 1.12 (1.03, 1.22), 1.22 (1.14, 1.30) and 1.12 (1.04, 1.20) for phosphate (0 h), phosphate (24 h) and delta phosphate, respectively. Curve fitting and threshold analyses showed that when phosphate (0 h) was between 5.6 mg/dl and 8.7 mg/dl,

Hypophosphatemia in critically ill adults and children – A systematic review

“…In general, subjects with a more severe illness are more likely to present with hypophosphatemia at admission [19,33]. However, hypophosphatemia at admission has also been shown to be an independent risk factor for 28-day mortality [34].…”

“…although not in all [26,27,[41][42][43][44]. In contrast, hypophosphatemia secondary to CRRT has limited clinical consequences in most retrospective studies [19,[45][46][47][48] (possibly related to "preventive" phosphate administration [49]), but not in all [34,48,50].…”

“…[53,54]. Association between hypophosphatemia and prolonged mechanical ventilation was shown in six out of eight studies [19,31,34,36,40,48].…”

The Effects of Serum Phosphate on 28-day Mortality in Patients Hospitalized in the Intensive Care Unit, Treated with Mechanical Ventilator Therapy and Treated with CRRT for Septic Shock-Induced Acute Kidney Injury

“…[18] yaptıkları bir çalışma da serum fosfatının ABH ı olan ve SRRT tedavisi alan septik hastaların prognozları ile ilişkili olduğunu göstermişlerdir. Bu çalışmanın bulguları ışığında serum fosfat düzeyi 0. saatte <5.6 mg/dL, 24. saatde ≤ 3.8 mg/dL ve delta fosfat -1'e ≥ olduğunda bu durum optimum serum fosfat düzeyidir ve 28 günlük mortaliteyi azaltır sonucuna ulaşmışlardır [18] . Bu çalışmaya göre günlük 1 mg/dL serum fosfat düzeyi artışı 28 günlük mortaliteyi arttırır.…”

“…Ancak Wang ve ark. [18] yaptığı çalışmada serum fosfat düzeyinin septik hastalarda 28. Günlük mortaliteye etkisini göstermişlerdir.…”