Impact of serum phosphate changes on in-hospital mortality

BMC Nephrology

Panupong Hansrivijit¹  Charat Thongprayoon²  Sorkko Thirunavukkarasu²  Api Chewcharat²  Kianoush B. Kashani³  Michael A. Mao⁴  Juan Medaura⁵  Wisit Cheungpasitporn⁵ 

[1] Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA, USA;Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First St SW, 55905, Rochester, MN, USA;Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First St SW, 55905, Rochester, MN, USA;Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA;Division of Nephrology and Hypertension, Mayo Clinic, 32224, Jacksonville, FL, USA;Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA;

关键词: Phosphate;    Electrolytes;    Hypophosphatemia;    Hyperphosphatemia;    Mortality;   

DOI  :  10.1186/s12882-020-02090-3

来源: Springer

【 摘 要 】

BackgroundFluctuations in serum phosphate levels increased mortality in end-stage renal disease patients. However, the impacts of serum phosphate changes in hospitalized patients remain unclear. This study aimed to test the hypothesis that serum phosphate changes during hospitalization were associated with in-hospital mortality.MethodsWe included all adult hospitalized patients from January 2009 to December 2013 that had at least two serum phosphate measurements during their hospitalization. We categorized in-hospital serum phosphate changes, defined as the absolute difference between the maximum and minimum serum phosphate, into 5 groups: 0–0.6, 0.7–1.3, 1.4–2.0, 2.1–2.7, ≥2.8 mg/dL. Using serum phosphate change group of 0–0.6 mg/dL as the reference group, the adjusted odds ratio of in-hospital mortality for various serum phosphate change groups was obtained by multivariable logistic regression analysis.ResultsA total of 28,149 patients were studied. The in-hospital mortality in patients with serum phosphate changes of 0–0.6, 0.7–1.3, 1.4–2.0, 2.1–2.7, ≥2.8 mg/dL was 1.5, 2.0, 3.1, 4.4, and 10.7%, respectively (p < 0.001). When adjusted for confounding factors, larger serum phosphate changes were associated with progressively increased in-hospital mortality with odds ratios of 1.35 (95% 1.04–1.74) in 0.7–1.3 mg/dL, 1.98 (95% CI 1.53–2.55) in 1.4–2.0 mg/dL, 2.68 (95% CI 2.07–3.48) in 2.1–2.7 mg/dL, and 5.04 (95% CI 3.94–6.45) in ≥2.8 mg/dL compared to serum phosphate change group of 0–0.6 mg/dL. A similar result was noted when we further adjusted for either the admission or mean serum phosphate during hospitalization.ConclusionGreater serum phosphate changes were progressively associated with increased in-hospital mortality.

【 授权许可】

CC BY