背景:低磷血症在危重患者中很常见。我们已经描述了重症监护病房患者低磷酸盐血症的流行病学。
方法:多中心,昆士兰州12个ICU的回顾性队列研究,澳大利亚1月1日2015年12月31日,2021年。排除包括再入院,肾脏替代疗法,终末期肾病,以及姑息性意图入院和从其他ICU转移。根据第一次低血清磷酸盐(PO4)的严重程度将患者分为四组:“无”(PO4:≥0.81mmol/L,“轻度”(PO4:≥0.50&<0.81mmol/L)“中度”(PO4:≥0.30&<0.50mmol/L)和“重度”(PO4:<0.30mmol/L)。混合效应逻辑回归模型,包括医院作为随机效应,旨在研究与90天病死率相关的因素。
结果:在89,776例患者中,68,699名患者被纳入本研究,23,485人(34.2%)患有低磷酸盐血症,主要在ICU入院第2天发病,并在发现低磷酸盐血症3天后纠正至正常。参与磷酸盐替代的ICU之间存在很大差异;阈值,以及它被替换的路线。第90天病死率随低磷酸盐血症的严重程度而增加(无:3,974(8.8%),轻度:2,306(11%),中度:377(14%);重度:108(21%)(p<0.001))。多因素回归分析显示,与无低磷血症者相比,中度(比值比(OR)1.24;95%置信区间(CI)1.07~1.44;p=0.004)或重度(OR1.49;95%CI1.13~1.97;p=0.005)低磷酸盐血症患者90天病死率风险增加.
结论:低磷血症很常见,主要发生在第2天,早期纠正血清磷酸盐。磷酸盐替代做法在ICU之间是可变的。中度和重度低磷血症与90天病死率增加相关。
BACKGROUND: 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: 3,974 (8.8%), Mild: 2,306 (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.
CONCLUSIONS: 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.