PDF(Pubmed)
Abstract：
BACKGROUND: Data is limited on the prevalence of hypophosphatemia in general hospitalized patients, and its association with length of hospital stay (LOS) and mortality remained unclear. We aimed to investigate the prevalence of admission phosphate abnormality and the association between serum phosphate level and length of hospital stay and all-cause mortality in adult patients.
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.
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.
摘要：
背景：关于一般住院患者低磷血症患病率的数据有限，其与住院时间(LOS)和死亡率的关系尚不清楚.我们旨在调查成年患者入院磷酸盐异常的患病率以及血清磷酸盐水平与住院时间和全因死亡率之间的关系。
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。
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。
