Lima Washington, Calderaro Débora Cerqueira, Passos Rogério, Côrte Margaret, Leal Jose Adalberto, Mayrink Marcelo Oliveira, Ferreira Gilda
Nutrition and Diet Service, Governador Israel Pinheiro Hospital - Instituto de Previdência Servidor do Estado de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Musculoskeletal System Department, Falculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
J Crit Care. 2023 Jun;75:154273. doi: 10.1016/j.jcrc.2023.154273. Epub 2023 Feb 2.
To evaluate lower mean phosphate as a prognostic tool in critically ill patients.
This is a prospective single-center cohort study including adult patients (> 18 years) with a length of intensive care unit (ICU) stay of at least 24 h. Phosphatemia was evaluated within 1 h of ICU admission and once daily. Mean phosphate, calculated by the simple arithmetic mean of daily phosphate measurements, was proposed and tested. Standard severity scores were applied. Multivariate and survival analyses were performed.
A total of 317 patients were included, of whom 111 (35%) presented hypophosphatemia. Hypophosphatemia associated with surgical conditions, nutritional therapy, hypovitaminosis D, hyperparathyroidism, mechanical ventilation (need and duration), and ICU and hospital length of stay were evaluated. Admission APACHE II and SOFA (ICU days 1, 3, and 7) scores and ICU and in-hospital mortality were greater in the hypophosphatemia group than control group. Higher APACHE II (RR: 1.1; 95%CI: 1.01-1.2; p = 0.045) and lower mean phosphate (RR: 0.02; 95%CI: 0.001-0.09; p = 0.044) independently predicted ICU and in-hospital mortality.
Hypophosphatemia is frequent in the ICU, and was associated with unfavorable outcomes. This study introduces the importance of longitudinal monitoring of phosphate levels, since lower mean phosphate is an independent predictor of mortality in critically ill patients.
评估较低的平均磷酸盐水平作为危重症患者预后工具的价值。
这是一项前瞻性单中心队列研究，纳入了入住重症监护病房（ICU）至少24小时的成年患者（>18岁）。在ICU入院后1小时内及每日评估一次血磷水平。提出并测试了通过每日血磷测量的简单算术平均值计算得出的平均磷酸盐水平。应用了标准严重程度评分。进行了多变量分析和生存分析。
共纳入317例患者，其中111例（35%）出现低磷血症。评估了与手术情况、营养治疗、维生素D缺乏、甲状旁腺功能亢进、机械通气（需求和持续时间）以及ICU和住院时间相关的低磷血症。低磷血症组的入院急性生理与慢性健康状况评分系统（APACHE II）和序贯器官衰竭评估（SOFA）评分（ICU第1、3和7天）以及ICU和院内死亡率均高于对照组。较高的APACHE II评分（相对危险度：1.1；95%置信区间：1.01 - 1.2；p = 0.045）和较低的平均磷酸盐水平（相对危险度：0.02；95%置信区间：0.001 - 0.09；p = 0.044）独立预测了ICU和院内死亡率。
ICU中低磷血症很常见，且与不良预后相关。本研究介绍了纵向监测磷酸盐水平的重要性，因为较低的平均磷酸盐水平是危重症患者死亡率的独立预测因素。
