Attokaran, Antony George, White, Kyle C., Doola, Ra'eesa, McIlroy, Philippa, Senthuran, Siva, Luke, Stephen, Garrett, Peter, Tabah, Alexis, Shekar, Kiran, Edwards, Felicity, White, Hayden, McCullough, James P.A., Hurford, Rod, Clement, Pierre, Laupland, Kevin B., Ramanan, Mahesh, and Queensland Critical Care Research Network Group (2024) Epidemiology of hypophosphatemia in critical illness: A multicentre, retrospective cohort study. Anaesthesia Critical Care & Pain Medicine, 43 (5). 101410.

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Abstract

Introduction: 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: 3974 (8.8%), Mild: 2306 (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.

Conclusion: 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.

Item ID:	85322
Item Type:	Article (Research - C1)
ISSN:	2352-5568
Keywords:	Critical illness, Electrolyte imbalance, Hypophosphatemia, Multicentre, Phosphate replacement
Copyright Information:	© 2024 Published by Elsevier Masson SAS on behalf of Socie´te´ franc¸aise d’anesthe´sie et de re´animation (Sfar).
Additional Information:	Members of Queensland Critical Care Research Network Group are listed in the article.
Date Deposited:	02 May 2025 05:18
FoR Codes:	42 HEALTH SCIENCES > 4202 Epidemiology > 420208 Nutritional epidemiology @ 50% 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320201 Anaesthesiology @ 50%
SEO Codes:	20 HEALTH > 2001 Clinical health > 200104 Prevention of human diseases and conditions @ 100%
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