Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Postgrad Med J. 2022 Jan;98(1155):43-47. doi: 10.1136/postgradmedj-2020-138872. Epub 2020 Oct 21.
We aimed to report the incidence of hospital-acquired hypophosphataemia and hyperphosphataemia along with their associated in-hospital mortality.
We included 15 869 adult patients hospitalised at a tertiary medical referral centre from January 2009 to December 2013, who had normal serum phosphate levels at admission and at least two serum phosphate measurements during their hospitalisation. The normal range of serum phosphate was defined as 2.5-4.2 mg/dL. In-hospital serum phosphate levels were categorised based on the occurrence of hospital-acquired hypophosphataemia and hyperphosphataemia. We analysed the association of hospital-acquired hypophosphataemia and hyperphosphataemia with in-hospital mortality using multivariable logistic regression.
Fifty-three per cent (n=8464) of the patients developed new serum phosphate derangements during their hospitalisation. The incidence of hospital-acquired hypophosphataemia and hyperphosphataemia was 35% and 27%, respectively. Hospital-acquired hypophosphataemia and hyperphosphataemia were associated with odds ratio (OR) of 1.56 and 2.60 for in-hospital mortality, respectively (p value<0.001 for both). Compared with patients with persistently normal in-hospital phosphate levels, patients with hospital-acquired hypophosphataemia only (OR 1.64), hospital-acquired hyperphosphataemia only (OR 2.74) and both hospital-acquired hypophosphataemia and hyperphosphataemia (ie, phosphate fluctuations; OR 4.00) were significantly associated with increased in-hospital mortality (all p values <0.001).
Hospital-acquired serum phosphate derangements affect approximately half of the hospitalised patients and are associated with increased in-hospital mortality rate.
本研究旨在报告医院获得性低磷血症和高磷血症的发生率及其与院内死亡率的相关性。
我们纳入了 2009 年 1 月至 2013 年 12 月在一家三级医疗转诊中心住院的 15869 名成年患者，这些患者入院时及住院期间至少有两次血清磷测量值均正常。血清磷的正常范围定义为 2.5-4.2mg/dL。根据住院期间是否发生医院获得性低磷血症和高磷血症，对住院期间的血清磷水平进行分类。采用多变量逻辑回归分析医院获得性低磷血症和高磷血症与院内死亡率的相关性。
53%（n=8464）的患者在住院期间出现新的血清磷紊乱。医院获得性低磷血症和高磷血症的发生率分别为 35%和 27%。医院获得性低磷血症和高磷血症与院内死亡率的比值比（OR）分别为 1.56 和 2.60（p 值均<0.001）。与住院期间血清磷水平持续正常的患者相比，仅发生医院获得性低磷血症（OR 1.64）、仅发生医院获得性高磷血症（OR 2.74）、以及同时发生医院获得性低磷血症和高磷血症（即磷波动；OR 4.00）的患者院内死亡率显著升高（所有 p 值均<0.001）。
医院获得性血清磷紊乱影响约半数住院患者，与院内死亡率升高相关。
