Broman Marcus, Wilsson Amanda M J, Hansson Fredrik, Klarin Bengt
From the *Skåne University Hospital, Lund, Getingevägen 4, SE-22185 Lund, Sweden; and †Science & Registry Nordic, Annedalsvägen 9, SE-22764 Lund, Sweden.
Anesth Analg. 2017 Jun;124(6):1897-1905. doi: 10.1213/ANE.0000000000002077.
Blood phosphate levels are vulnerable to fluctuations and changes in phosphate levels are often neglected. The aim of this study was to evaluate whether deviations in phosphate levels correlate to higher 180-day overall mortality or morbidity.
Four thousand six hundred fifty-six patients with 19,467 phosphate values treated at the adult intensive care unit at Skåne University Hospital, Lund, Sweden during 2006-2014 were retrospectively divided into a control group and 3 study groups: hypophosphatemia, hyperphosphatemia, and a mixed group showing both hypo/hyperphosphatemia. Sex, age, disease severity represented by maximal organ system Sequential Organ Failure Assessment score, renal Sequential Organ Failure Assessment score, lowest ionized calcium value, and diagnoses classes were included in a Cox hazard model to adjust for confounding factors, with time to death in the first 180 days from the intensive care unit (ICU) admission as outcome.
When compared to normophosphatemic controls, the hyperphosphatemic study group was associated with higher risk of death with a hazard ratio of 1.2 (98.3% confidence interval 1.0-1.5, P = .0089). Mortality in the hypophosphatemic or mixed study group did not differ from controls. The mixed group showed markedly longer ventilator times and ICU stays compared to all other groups.
Phosphate alterations in ICU patients are common and associated with worse morbidity and mortality. Many underlying pathophysiologic mechanisms may play a role. A rapidly changing phosphate level or isolated hypo or hyperphosphatemia should be urgently corrected.
血磷水平易波动，而磷水平的变化常被忽视。本研究旨在评估磷水平偏差是否与180天的总体死亡率或发病率升高相关。
回顾性分析2006年至2014年期间在瑞典隆德斯科讷大学医院成人重症监护病房接受治疗的4656例患者的19467次磷值，将其分为对照组和3个研究组：低磷血症组、高磷血症组和同时出现低磷/高磷血症的混合组。将性别、年龄、以最大器官系统序贯器官衰竭评估评分表示的疾病严重程度、肾脏序贯器官衰竭评估评分、最低离子钙值和诊断类别纳入Cox风险模型以调整混杂因素，以重症监护病房（ICU）入院后前180天的死亡时间作为结局。
与血磷正常的对照组相比，高磷血症研究组的死亡风险更高，风险比为1.2（98.3%置信区间1.0 - 1.5，P = 0.0089）。低磷血症或混合研究组的死亡率与对照组无差异。与所有其他组相比，混合组的机械通气时间和ICU住院时间明显更长。
ICU患者的磷改变常见，且与更差的发病率和死亡率相关。许多潜在的病理生理机制可能起作用。应紧急纠正快速变化的磷水平或孤立的低磷或高磷血症。
