Liu Zheng, Li Teng, Du Yihan, Li Chenhu, Chong Wei
The First Affiliated Hospital of China Medical University, Shenyang, China.
Front Nephrol. 2022 Aug 1;2:935288. doi: 10.3389/fneph.2022.935288. eCollection 2022.
This study was intended to explore the relationship between level of serum phosphate and prognosis in septic patients.
Data were obtained from the public database, which were divided into 2 subgroups according to whether they were complicated with chronic kidney disease. Initial values of serum phosphate were extracted from patients on admission to hospital. Propensity score-matched analysis was performed. The relationship between hypophosphatemia, hyperphosphatemia and the severity of the disease in septic patients was explored separately. The lowess smoothing technique and the Kaplan-Meier method were utilized for a preliminary analysis of serum phosphate levels in relation to in-hospital mortality and 28-day survival. The initial values of serum phosphate were graded as level 1 (<1.5 mg/dL), level 2 (1.5-2.7 mg/dL), level 3 (2.7-4.5 mg/dL), level 4 (4.5-5.5 mg/dL), level 5 (5.5-6.5 mg/dL), level 6 (6.5-7.5 mg/dL) and level 7 (> 7.5 mg/dL). Multivariate logistic regression and cox regression was used to analyse the relationship between serum phosphate levels and mortality.
There were 4059 cases (17.4%) combined with chronic kidney disease, including 419 cases (10.3%) with hypophosphatemia and 1091 cases (26.8%) with hyperphosphatemia. There were 19224 cases (82.6%) not combined with chronic kidney disease, including 3769 cases (19.6%) hypophosphatemia and 2158 cases (11.2%) hyperphosphatemia. After propensity score-matched, in-hospital mortality, 28-day mortality, risk of septic shock was significantly higher in the 2 subgroups of hypophosphatemia patients than in normophosphatemia patients. In-hospital mortality, 28-day mortality, risk of septic shock, occurrence of renal replacement therapy, occurrence of acute renal failure, and maximum clinical score were all significantly higher in the 2 subgroups of patients with hyperphosphatemia than in patients with normophosphatemia. Multivariate logistic regression was consistent with cox regression results. In septic patients without chronic kidney disease, hypophosphatemia was an independent risk factor for death. When serum phosphate was lower, the risk of death was higher. In all septic patients, hyperphosphatemia was an independent risk factor for death. When serum phosphate was higher, the risk of death was greater.
Both hypophosphatemia and hyperphosphatemia are associated with increased mortality in septic patients and are independent risk factors for death.
本研究旨在探讨脓毒症患者血清磷酸盐水平与预后之间的关系。
数据来源于公共数据库，根据是否合并慢性肾脏病分为2个亚组。提取患者入院时血清磷酸盐的初始值。进行倾向评分匹配分析。分别探讨脓毒症患者低磷血症、高磷血症与疾病严重程度之间的关系。采用局部加权散点平滑技术和Kaplan-Meier法对血清磷酸盐水平与住院死亡率及28天生存率的关系进行初步分析。血清磷酸盐的初始值分为1级（<1.5mg/dL）、2级（1.5 - 2.7mg/dL）、3级（2.7 - 4.5mg/dL）、4级（4.5 - 5.5mg/dL）、5级（5.5 - 6.5mg/dL）、6级（6.5 - 7.5mg/dL）和7级（>7.5mg/dL）。采用多因素logistic回归和Cox回归分析血清磷酸盐水平与死亡率之间的关系。
合并慢性肾脏病的有4059例（17.4%），其中低磷血症患者419例（10.3%），高磷血症患者1091例（26.8%）。未合并慢性肾脏病的有19224例（82.6%），其中低磷血症患者3769例（19.6%），高磷血症患者2158例（11.2%）。倾向评分匹配后，低磷血症患者的2个亚组的住院死亡率、28天死亡率、脓毒症休克风险均显著高于正常磷血症患者。高磷血症患者的2个亚组的住院死亡率、28天死亡率、脓毒症休克风险、肾脏替代治疗发生率、急性肾衰竭发生率及最高临床评分均显著高于正常磷血症患者。多因素logistic回归与Cox回归结果一致。在无慢性肾脏病的脓毒症患者中，低磷血症是死亡的独立危险因素。血清磷酸盐水平越低，死亡风险越高。在所有脓毒症患者中，高磷血症是死亡的独立危险因素。血清磷酸盐水平越高，死亡风险越大。
低磷血症和高磷血症均与脓毒症患者死亡率增加相关，且均为死亡的独立危险因素。
