低磷酸盐血症(血清磷酸盐<2.5mg/dL)是开始营养支持时的主要问题。我们评估了哪些因素有助于危重患者的低磷酸盐血症发展,以及低磷酸盐血症和死亡率之间的关系。在16张病床的混合ICU中通气至少2天的患者的回顾性队列研究。收集的数据包括人口统计,急性生理学和慢性健康评估2(APACHE2)入院评分,24小时序贯器官衰竭评估评分(SOFA24),每小时的能源交付,入院前2周血浆磷酸盐水平,ICU住院时间(LOS),通风长度(LOV),和死亡率(ICU和90天)。对于低磷酸盐血症发展模型,我们认为死亡率是一种竞争风险.对于死亡率分析,我们使用Cox比例风险模型,将低磷酸盐血症的发生视为随时间变化的协变量.462例患者用于分析。59.52%的患者出现低磷酸盐血症。几个因素与低磷酸盐血症的风险降低相关:年龄,BMI,入院前糖尿病诊断,APACHE2,SOFA24,第一肾SOFA评分,ICU入院前入院时间,肝移植后入院。由于创伤而入院与低磷酸盐血症的风险增加相关。以低磷血症为时变协变量的生存分析显示低磷血症对死亡率有保护作用(HR0.447,95%CI0.281,0.712)。年龄,APACHE2和SOFA24评分与ICU死亡率显著相关。在开始营养支持之前,ICU中的禁食时间未发现与低磷酸盐血症显着相关。我们检查了几个禁食间隔(12小时,24h,36h,48h,60小时,72小时)。在每个快速间隔中,我们比较了禁食指定时间长度的患者的低磷血症患病率,与那些没有禁食相同时间的人。在每个禁食间隔中,与非空腹组相比,空腹组的低磷血症患病率较低.然而,这种差异是微不足道的。BMI,入院前APACHE2和住院LOS与低磷酸盐血症的发生呈负相关。在开始营养支持之前,在ICU禁食长达72小时不会影响低磷酸盐血症的发生。低磷血症与较低的死亡率相关。
Hypophosphatemia (serum phosphate < 2.5 mg/dL) is a major concern when initiating nutritional support. We evaluated which factors contribute to hypophosphatemia development in critically ill patients, as well as the association between
hypophosphatemia and mortality. A retrospective cohort study of patients who were ventilated for at least 2 days in a 16-bed mixed ICU. Data collected includes demographics, Acute Physiology & Chronic Health Evaluation 2 (APACHE2) admission score, Sequential Organ Failure Assessment score at 24 h (SOFA24), hourly energy delivery, plasma phosphate levels during the first 2 weeks of admission, ICU length of stay (LOS), length of ventilation (LOV), and mortality (ICU and 90 days). For the hypophosphatemia development model, we considered mortality as a competing risk. For mortality analysis, we used the Cox proportional hazards model considering hypophosphatemia development as a time-varying covariate. 462 patients were used in the analysis. 59.52% of the patients developed hypophosphatemia. Several factors were associated with a decreased risk of hypophosphatemia: age, BMI, pre-admission diabetes diagnosis, APACHE2, SOFA24, first kidney SOFA score, hospital admission time before ICU admission, and admission after liver transplantation. Admission due to trauma was associated with an increased risk of
hypophosphatemia. Survival analysis with
hypophosphatemia as a time-varying covariate showed a protective effect of
hypophosphatemia from mortality (HR 0.447, 95% CI 0.281, 0.712). Age, APACHE2, and SOFA24 score were found to be significantly associated with ICU mortality. Fasting duration in the ICU before nutritional support initiation was not found to be significantly associated with hypophosphatemia. We examined several fasting intervals (12 h, 24 h, 36 h, 48 h, 60 h, 72 h). In each fast interval, we compared the prevalence of hypophosphatemia among patients who fasted the specified length of time, with those who did not fast for the same length of time. In each fasting interval, hypophosphatemia prevalence was lower in the fasting group compared to the non-fasting group. However, this difference was insignificant. BMI, APACHE2, and hospital LOS before ICU admission were inversely associated with hypophosphatemia development. Fasting for up to 72 h in the ICU before starting nutritional support did not affect hypophosphatemia occurrence.
Hypophosphatemia was associated with lower mortality.