Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, The Republic of Korea.
Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, The Republic of Korea
Emerg Med J. 2020 Jun;37(6):355-361. doi: 10.1136/emermed-2019-208976. Epub 2020 Apr 22.
Ischaemic tissue injury caused by tissue hypoperfusion is one of the major consequences of sepsis. Phosphate concentrations are elevated in ischaemic tissue injury. This study was performed to investigate the association of phosphate concentrations with mortality in patients with sepsis.
This was a retrospective cohort study of patients with sepsis conducted at an urban, tertiary care emergency department (ED) in Korea. Patients with sepsis arriving between March 2010 and April 2017 were stratified into four groups according to the initial phosphate concentration at presentation to the ED: group I (hypophosphataemia, phosphate <2 mg/dL), group II (normophosphataemia, phosphate 2-4 mg/dL), group III (mild hyperphosphataemia, phosphate 4-6 mg/dL), group IV (moderate to severe hyperphosphataemia, phosphate ≥6 mg/dL). Multivariable Cox proportional hazard regression analyses were performed to evaluate the independent association of initial phosphate concentration with 28-day mortality.
Of the 3034 participants in the study, the overall mortality rate was 21.9%. The 28-day mortality rates were group I (hypophosphataemia) 14.6%, group II 17.4% (normophosphataemia), group III (mild hyperphosphataemia) 29.2% and group IV (moderate to severe hyperphosphataemia) 51.4%, respectively (p<0.001). In the multivariable analyses, patients with severe hyperphosphataemia had a significantly higher risk of death than those with normal phosphate levels (HR 1.59; 95% CI 1.23 to 2.05). Mortality in the other groups was not significantly different from mortality in patients with normophosphataemia.
Moderate to severe hyperphosphataemia was associated with 28-day mortality in patients with sepsis. Phosphate level could be used as a prognostic indicator in sepsis.
组织低灌注引起的缺血性组织损伤是脓毒症的主要后果之一。在缺血性组织损伤中，磷酸盐浓度升高。本研究旨在探讨磷酸盐浓度与脓毒症患者死亡率之间的关系。
这是一项在韩国一家城市三级保健急诊室进行的脓毒症患者回顾性队列研究。根据入院时初始磷酸盐浓度，将脓毒症患者分为四组：I 组（低磷酸盐血症，磷酸盐<2mg/dL）、II 组（正常磷酸盐血症，磷酸盐 2-4mg/dL）、III 组（轻度高磷酸盐血症，磷酸盐 4-6mg/dL）、IV 组（中重度高磷酸盐血症，磷酸盐≥6mg/dL）。采用多变量 Cox 比例风险回归分析评估初始磷酸盐浓度与 28 天死亡率的独立相关性。
在 3034 名研究参与者中，总体死亡率为 21.9%。28 天死亡率分别为 I 组（低磷酸盐血症）14.6%、II 组（正常磷酸盐血症）17.4%、III 组（轻度高磷酸盐血症）29.2%和 IV 组（中重度高磷酸盐血症）51.4%（p<0.001）。多变量分析显示，严重高磷酸盐血症患者死亡风险明显高于正常磷酸盐血症患者（HR 1.59；95%CI 1.23 至 2.05）。其他组的死亡率与正常磷酸盐血症患者的死亡率无显著差异。
中重度高磷酸盐血症与脓毒症患者 28 天死亡率相关。磷酸盐水平可作为脓毒症的预后指标。
