Yang Chi-Ju, Chang Chia-Ming, Chang Gyu-Ping, Tsai Huei-Ting, Yu Ting-Yu, Han Yin-Yi
Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Environment and Occupational Health Sciences, National Taiwan University, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Formos Med Assoc. 2025 Jun;124(6):563-568. doi: 10.1016/j.jfma.2024.06.010. Epub 2024 Jun 16.
Phosphorus is a vital mineral crucial for various physiological functions. Critically ill trauma patients frequently experience hypophosphatemia during the immediate post-traumatic phase, potentially impacting outcomes. This study aims to investigate the incidence of early hypophosphatemia in critically major trauma patients.
In this prospective observational study, trauma patients admitted to the intensive care unit (ICU) within one day were enrolled. These patients were categorized into Hypo-P groups and Non-hypo groups based on the development of new-onset hypophosphatemia within 72 h after feeding. The primary outcome assessed was the incidence of new-onset hypophosphatemia. The secondary outcomes included ICU and hospital stay, ventilation duration, and mortality.
76.1% of patients developed a new onset of hypophosphatemia within 72 h after feeding. The Hypo-P group had significantly longer ICU stays (8.1 days ± 5.5 vs. 4.4 days ± 3.1; p = 0.0251) and trends towards extended hospital stay, ventilation duration, and higher mortality. Additionally, they demonstrated significantly higher urine fractional excretion of phosphate (FEPO) on the first ICU day (29.2% ± 14.23 vs. 19.5% ± 8.39; p = 0.0242).
Critically ill trauma patients exhibited a significantly higher incidence of early hypophosphatemia than typical ICU rates, indicating their heightened vulnerability. The significantly high urine FEPO underscores the crucial role of renal loss in disrupting phosphate metabolism in this early acute phase after trauma. A significant correlation was observed between hypophosphatemia and longer ICU stays. Monitoring and managing phosphate levels may influence outcomes, warranting further investigation.
磷是一种对各种生理功能至关重要的必需矿物质。重症创伤患者在创伤后即刻阶段经常发生低磷血症，这可能会影响治疗结果。本研究旨在调查重症主要创伤患者早期低磷血症的发生率。
在这项前瞻性观察研究中，纳入了在一天内入住重症监护病房（ICU）的创伤患者。根据进食后72小时内新发低磷血症的发生情况，将这些患者分为低磷组和非低磷组。评估的主要结局是新发低磷血症的发生率。次要结局包括ICU住院时间、住院时间、通气时间和死亡率。
76.1%的患者在进食后72小时内出现新发低磷血症。低磷组的ICU住院时间明显更长（8.1天±5.5天 vs. 4.4天±3.1天；p = 0.0251），并且在住院时间延长、通气时间和更高死亡率方面有趋势。此外，他们在ICU的第一天尿磷排泄分数（FEPO）明显更高（29.2%±14.23 vs. 19.5%±8.39；p = 0.0242）。
重症创伤患者早期低磷血症的发生率明显高于典型的ICU发生率，表明他们的易感性更高。尿FEPO显著升高强调了肾丢失在创伤后早期急性期破坏磷代谢中的关键作用。观察到低磷血症与更长的ICU住院时间之间存在显著相关性。监测和管理磷水平可能会影响治疗结果，值得进一步研究。
