Wen Tao, Mao Zhi, Liu Chao, Wang Xiaoli, Tian Shufen, Zhou Feihu
Medical School of Chinese PLA, Beijing, China; Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China; Xinxing Bridge Clinic, Southern Medical District of Chinese PLA General Hospital, Beijing, China.
Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
Injury. 2023 Jan;54(1):189-197. doi: 10.1016/j.injury.2022.10.024. Epub 2022 Oct 30.
The incidence of acute kidney injury (AKI) is high in critically ill patients with rhabdomyolysis. Limited evidence was proved of the association between serum phosphate levels at intensive care unit (ICU) admission and the subsequent risk of AKI. Our study aims to assess if serum phosphate levels at admission were independently associated with AKI risk in these patients.
This study extracted and analyzed data from Medical Information Mart for Intensive Care-Ⅲ (MIMIC-Ⅲ, version1.4). Rhabdomyolysis was defined as a peak creatine kinase (CK) level higher than 1000 U/L. Serum phosphate was measured within the first day into the ICU and was categorized to 4 groups (<2.6, 2.6-3.4, 3.5-4.5, >4.5mg/dl). AKI was defined according to the Kidney Disease Improving Global Outcome (KDIGO) guidelines. Adjusted smoothing spline plots and multivariable logistic regressions were carried out to explode the association between serum phosphate and risk of AKI. Subgroup analyse was applied to verify the consistency of the association.
Three hundred and twenty-one patients (68% male) diagnosed as rhabdomyolysis were eligible for this analysis. AKI occurred in 204 (64%) patients of total. Incidence of AKI with admission serum phosphate groups<2.6, 2.6-3.4, 3.5-4.5 and>4.5mg/dl were 53%, 57%, 68% and 76%, respectively. Smoothing spline curve showed that there was a positive curve between the elevated phosphate values and increasing risk of AKI, and there was no threshold saturation effect. In multivariable logistic regression, OR was 1.2 (95%CI 1.0-1.5, P=0.035, P trend=0.041) after adjusting confounders. Subgroup analyses proved the consistency of the relationship in these patients, possibly, except in the strata of potassium.
In rhabdomyolysis patients admitted to ICU, serum phosphate levels at admission were independently associated with an increased risk of AKI. As phosphate levels rise, the risk of AKI increased.
横纹肌溶解症的重症患者急性肾损伤（AKI）的发生率很高。关于重症监护病房（ICU）入院时血清磷酸盐水平与随后发生AKI风险之间的关联，证据有限。我们的研究旨在评估入院时血清磷酸盐水平是否与这些患者的AKI风险独立相关。
本研究从重症监护医学信息数据库Ⅲ（MIMIC-Ⅲ，版本1.4）中提取并分析数据。横纹肌溶解症定义为肌酸激酶（CK）峰值水平高于1000 U/L。在进入ICU的第一天内测量血清磷酸盐，并将其分为4组（<2.6、2.6-3.4、3.5-4.5、>4.5mg/dl）。根据改善全球肾脏病预后（KDIGO）指南定义AKI。进行调整后的平滑样条图和多变量逻辑回归分析血清磷酸盐与AKI风险之间的关联。应用亚组分析来验证该关联的一致性。
321例诊断为横纹肌溶解症的患者（68%为男性）符合本分析条件。总共有204例（64%）患者发生了AKI。入院血清磷酸盐水平<2.6、2.6-3.4、3.5-4.5和>4.5mg/dl组的AKI发生率分别为53%、57%、68%和76%。平滑样条曲线显示，磷酸盐值升高与AKI风险增加之间存在正相关曲线，且无阈值饱和效应。在多变量逻辑回归中，调整混杂因素后，比值比为1.2（95%置信区间1.0-1.5，P=0.035，P趋势=0.041）。亚组分析证明了这些患者中这种关系的一致性，可能除了钾分层情况。
在入住ICU的横纹肌溶解症患者中，入院时血清磷酸盐水平与AKI风险增加独立相关。随着磷酸盐水平升高，AKI风险增加。
