Department of Anaesthesiology and Intensive Care, University of Tartu, Estonia; Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium.
Clin Nutr. 2021 Apr;40(4):1744-1754. doi: 10.1016/j.clnu.2020.09.045. Epub 2020 Oct 8.
BACKGROUND & AIMS: Phosphate is the main intracellular anion essential for numerous biological processes. Symptoms of hypophosphatemia are non-specific, yet potentially life-threatening. This systematic review process was initiated to gain a global insight into hypophosphatemia, associated morbidity and treatments.
A systematic review was conducted (PROSPERO CRD42020163191). Nine clinically relevant questions were generated, seven for adult and two for pediatric critically ill patients, and prevalence of hypophosphatemia was assessed in both groups. We identified trials through systematic searches of Medline, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. Quality assessment was performed using the Cochrane risk of bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies.
For all research questions, we identified 2727 titles in total, assessed 399 full texts, and retained 82 full texts for evidence synthesis, with 20 of them identified for several research questions. Only 3 randomized controlled trials were identified with two of them published only in abstract form, as well as 28 prospective and 31 retrospective studies, and 20 case reports. Relevant risk of bias regarding selection and comparability was identified for most of the studies. No meta-analysis could be performed. The prevalence of hypophosphatemia varied substantially in critically ill adults and children, but no study assessed consecutive admissions to intensive care. In both critically ill adults and children, several studies report that hypophosphatemia is associated with worse outcome (prolonged length of stay and the need for respiratory support, and higher mortality). However, there was insufficient evidence regarding the optimal threshold upon which hypophosphatemia becomes critical and requires treatment. We found no studies regarding the optimal frequency of phosphate measurements, and regarding the time window to correct hypophosphatemia. In adults, nutrient restriction on top of phosphate repletion in patients with refeeding syndrome may improve survival, although evidence is weak.
Evidence on the definition, outcome and treatment of clinically relevant hypophosphatemia in critically ill adults and children is scarce and does not allow answering clinically relevant questions. High quality clinical research is crucial for the development of respective guidelines.
磷酸盐是细胞内的主要阴离子，对许多生物过程至关重要。低磷酸盐血症的症状不具有特异性，但可能有生命危险。本系统综述旨在全面了解低磷酸盐血症、相关发病率和治疗方法。
进行了系统综述（PROSPERO CRD42020163191）。生成了 9 个与临床相关的问题，其中 7 个用于成年危重症患者，2 个用于儿科危重症患者，并评估了两组患者的低磷酸盐血症患病率。我们通过系统检索 Medline、EMBASE、Scopus、Cochrane 对照试验中心注册库、CINAHL 和 Web of Science 来确定试验。使用 Cochrane 随机对照试验偏倚风险工具和纽卡斯尔-渥太华量表对观察性研究进行质量评估。
对于所有研究问题，我们总共确定了 2727 个标题，评估了 399 篇全文，并保留了 82 篇全文进行证据综合，其中 20 篇涉及多个研究问题。仅确定了 3 项随机对照试验，其中 2 项仅以摘要形式发表，还有 28 项前瞻性研究和 31 项回顾性研究，以及 20 项病例报告。大多数研究都存在关于选择和可比性的相关偏倚风险。无法进行荟萃分析。危重症成人和儿童中低磷酸盐血症的患病率差异很大，但没有研究评估连续入住重症监护病房的情况。在危重症成人和儿童中，有几项研究报告低磷酸盐血症与更差的预后（住院时间延长和需要呼吸支持，以及更高的死亡率）相关。然而，关于低磷酸盐血症变得严重并需要治疗的最佳阈值，证据不足。我们没有找到关于磷酸盐测量的最佳频率以及纠正低磷酸盐血症的时间窗口的研究。在成人中，在再喂养综合征患者中补充磷酸盐的同时限制营养可能会提高生存率，但证据较弱。
关于危重症成人和儿童中临床相关低磷酸盐血症的定义、结局和治疗的证据很少，无法回答临床相关问题。高质量的临床研究对于制定相应的指南至关重要。
