接受持续肾脏替代治疗的危重症儿童血清磷与死亡率之间的关系。
Relationship between serum phosphate and mortality in critically ill children receiving continuous renal replacement therapy.
作者信息
Zhou Xiong, He Jie, Zhu Desheng, Yao Zhenya, Peng Dan, Zhang Xinping
机构信息
Pediatric Department of Critical Care Medicine, Hunan Children's Hospital, Changsha, China.
出版信息
Front Pediatr. 2023 Apr 12;11:1129156. doi: 10.3389/fped.2023.1129156. eCollection 2023.
PURPOSE
We aimed to explore the relationship between serum phosphate concentration and 90-day mortality in critically ill children receiving continuous renal replacement therapy (CRRT).
METHODS
Data from the medical records of children aged <13 years who received CRRT at the Pediatric Intensive Care Unit of Hunan Children's Hospital, China from January 2015 to June 2020 were retrospectively collected. Children were grouped into four categories according to the baseline phosphate concentration before CRRT and mean serum phosphate concentration during CRRT: <0.81 mmol/L (hypophosphatemia), 0.81-1.19 mmol/L, 1.2-2.4 mmol/L (normal phosphate concentration), and >2.4 mmol/L (hyperphosphatemia), with the normal phosphate group serving as the comparator group. The correlation of the serum phosphate concentration before and during CRRT with the 90-day mortality after CRRT initiation was analyzed using logistic regression.
RESULTS
A total of 177 children were included in our study. The mean serum phosphate concentration before CRRT was 1.46 mmol/L (quartiles: 1.04, 2.20). The 90-day mortality rate was increased in children with a serum phosphate concentration >2.4 mmol/L before CRRT (adjusted odds ratio [aOR] 3.74, 95% confidence interval [CI] 1.42-9.86, = 0.008). The mean serum phosphate concentration during CRRT was 1.2 mmol/L (quartiles: 0.91, 1.49). The 90-day mortality rate was increased in children with a mean serum phosphate concentration >2.4 mmol/L during CRRT (aOR 7.34, 95% CI 1.59-33.88, = 0.011).
CONCLUSION
Hyperphosphatemia before and during CRRT predicts a higher 90-day mortality rate.
目的
我们旨在探讨接受持续肾脏替代治疗（CRRT）的危重症儿童血清磷酸盐浓度与90天死亡率之间的关系。
方法
回顾性收集2015年1月至2020年6月在中国湖南省儿童医院儿科重症监护病房接受CRRT的13岁以下儿童的病历数据。根据CRRT前的基线磷酸盐浓度和CRRT期间的平均血清磷酸盐浓度，将儿童分为四类：<0.81 mmol/L（低磷血症）、0.81-1.19 mmol/L、1.2-2.4 mmol/L（正常磷酸盐浓度）和>2.4 mmol/L（高磷血症），以正常磷酸盐组作为对照组。采用逻辑回归分析CRRT前和期间的血清磷酸盐浓度与CRRT开始后90天死亡率的相关性。
结果
我们的研究共纳入177名儿童。CRRT前的平均血清磷酸盐浓度为1.46 mmol/L（四分位数：1.04，2.20）。CRRT前血清磷酸盐浓度>2.4 mmol/L的儿童90天死亡率增加（调整优势比[aOR] 3.74，95%置信区间[CI] 1.42-9.86，P = 0.008）。CRRT期间的平均血清磷酸盐浓度为1.2 mmol/L（四分位数：0.91，1.49）。CRRT期间平均血清磷酸盐浓度>2.4 mmol/L的儿童90天死亡率增加（aOR 7.34，95% CI 1.59-33.88，P = 0.011）。
结论
CRRT前和期间的高磷血症预示着90天死亡率更高。
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