METHODS: This was a multi-center retrospective study based on real-world data. Participants were classified into five groups according to serum phosphate level (inorganic phosphorus, iP) within 48 h after admission: G1, iP < 0.64 mmol/L; G2, iP 0.64-0.8 mmol/L; G3, iP 0.8-1.16 mmol/L; G4, iP 1.16-1.45 mmol/L; and G5, iP ≥ 1.45 mmol/L, respectively. Both LOS and in-hospital mortality were considered as outcomes. Clinical information, including age, sex, primary diagnosis, co-morbidity, and phosphate-metabolism related parameters, were also abstracted from medical records.
RESULTS: A total number of 23,479 adult patients (14,073 males and 9,406 females, aged 57.7 ± 16.8 y) were included in the study. The prevalence of hypophosphatemia was 4.74%. An \"L-shaped\" non-linear association was determined between serum phosphate level and LOS and the inflection point was 1.16 mmol/L in serum phosphate level. Compared with patients in G4, patients in G1, G2 or G3 were significantly associated with longer LOS after full adjustment of covariates. Each 0.1 mmol/L decrease in serum phosphate level to the left side of the inflection point led to 0.64 days increase in LOS [95% confidence interval (CI): 0.46, 0.81; p for trend < 0.001]. But there was no association between serum phosphate and LOS where serum levels of phosphate ≥ 1.16 mmol/L. Multivariable logistic regression analysis showed that adjusted all-cause in-hospital mortality was 3.08-fold greater in patients in G1 than those in G4 (95% CI: 1.52, 6.25; p for trend = 0.001). Similarly, no significant association with either LOS or mortality were found in patients in G5, comparing with G4.
CONCLUSIONS: Hypophosphatemia, but not hyperphosphatemia, was associated with LOS and all-cause mortality in adult inpatients. It is meaningful to monitor serum levels of phosphate to facilitate early diagnosis and intervention.
方法:这是一项基于真实世界数据的多中心回顾性研究。根据血清磷酸盐水平将参与者分为五组(无机磷,iP)入院后48h内:G1,iP<0.64mmol/L;G2,iP0.64-0.8mmol/L;G3,iP0.8-1.16mmol/L;G4,iP1.16-1.45mmol/L;G5,iP≥1.45mmol/L,分别。LOS和院内死亡率均被视为结果。临床信息,包括年龄,性别,初步诊断,合并症,和磷酸盐代谢相关参数,也是从医疗记录中提取的。
结果:共有23,479名成人患者(男性14,073名,女性9,406名,57.7±16.8岁)纳入研究。低磷血症的患病率为4.74%。在血清磷酸盐水平与LOS之间确定了“L形”非线性关联,并且血清磷酸盐水平的拐点为1.16mmol/L。与G4患者相比,G1,G2或G3患者在充分调整协变量后与更长的LOS显着相关。拐点左侧的血清磷酸盐水平每降低0.1mmol/L导致LOS增加0.64天[95%置信区间(CI):0.46,0.81;趋势p<0.001]。但是血清磷酸盐水平≥1.16mmol/L时,血清磷酸盐与LOS之间没有关联。多变量logistic回归分析显示,G1期患者调整后的全因住院死亡率比G4期高3.08倍(95%CI:1.52,6.25;趋势p=0.001)。同样,与G4相比,G5组患者与LOS或死亡率均无显著关联.
结论:低磷血症,但不是高磷血症,与成人住院患者的LOS和全因死亡率相关。监测血清磷酸盐水平对早期诊断和干预具有重要意义。