Department of General Intensive Care, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel.
School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Sci Rep. 2024 Aug 26;14(1):19771. doi: 10.1038/s41598-024-68688-x.
Hypophosphatemia (serum phosphate < 2.5 mg/dL) is a major concern when initiating nutritional support. We evaluated which factors contribute to hypophosphatemia development in critically ill patients, as well as the association between hypophosphatemia and mortality. A retrospective cohort study of patients who were ventilated for at least 2 days in a 16-bed mixed ICU. Data collected includes demographics, Acute Physiology & Chronic Health Evaluation 2 (APACHE2) admission score, Sequential Organ Failure Assessment score at 24 h (SOFA24), hourly energy delivery, plasma phosphate levels during the first 2 weeks of admission, ICU length of stay (LOS), length of ventilation (LOV), and mortality (ICU and 90 days). For the hypophosphatemia development model, we considered mortality as a competing risk. For mortality analysis, we used the Cox proportional hazards model considering hypophosphatemia development as a time-varying covariate. 462 patients were used in the analysis. 59.52% of the patients developed hypophosphatemia. Several factors were associated with a decreased risk of hypophosphatemia: age, BMI, pre-admission diabetes diagnosis, APACHE2, SOFA24, first kidney SOFA score, hospital admission time before ICU admission, and admission after liver transplantation. Admission due to trauma was associated with an increased risk of hypophosphatemia. Survival analysis with hypophosphatemia as a time-varying covariate showed a protective effect of hypophosphatemia from mortality (HR 0.447, 95% CI 0.281, 0.712). Age, APACHE2, and SOFA24 score were found to be significantly associated with ICU mortality. Fasting duration in the ICU before nutritional support initiation was not found to be significantly associated with hypophosphatemia. We examined several fasting intervals (12 h, 24 h, 36 h, 48 h, 60 h, 72 h). In each fast interval, we compared the prevalence of hypophosphatemia among patients who fasted the specified length of time, with those who did not fast for the same length of time. In each fasting interval, hypophosphatemia prevalence was lower in the fasting group compared to the non-fasting group. However, this difference was insignificant. BMI, APACHE2, and hospital LOS before ICU admission were inversely associated with hypophosphatemia development. Fasting for up to 72 h in the ICU before starting nutritional support did not affect hypophosphatemia occurrence. Hypophosphatemia was associated with lower mortality.
低磷血症（血清磷酸盐 < 2.5 mg/dL）是开始营养支持时的主要关注点。我们评估了哪些因素导致危重症患者低磷血症的发展，以及低磷血症与死亡率之间的关系。这是一项对至少在 16 张混合 ICU 床位中通气 2 天以上的患者进行的回顾性队列研究。收集的数据包括人口统计学资料、急性生理学和慢性健康评估 2 （APACHE2）入院评分、24 小时序贯器官衰竭评估评分（SOFA24）、每小时能量输送、入院前 2 周内的血浆磷酸盐水平、重症监护病房住院时间（LOS）、通气时间（LOV）和死亡率（ICU 和 90 天）。对于低磷血症发展模型，我们将死亡率视为竞争风险。对于死亡率分析，我们使用 Cox 比例风险模型，将低磷血症的发展视为随时间变化的协变量。共分析了 462 例患者。59.52%的患者发生了低磷血症。一些因素与低磷血症风险降低有关：年龄、BMI、入院前糖尿病诊断、APACHE2、SOFA24、第一个肾脏 SOFA 评分、入住 ICU 前的住院时间和肝移植后入院。因创伤而入院与低磷血症的发生风险增加有关。将低磷血症作为随时间变化的协变量进行生存分析显示，低磷血症对死亡率有保护作用（HR 0.447，95%CI 0.281，0.712）。年龄、APACHE2 和 SOFA24 评分与 ICU 死亡率显著相关。在开始营养支持前 ICU 中的禁食时间与低磷血症无显著相关性。我们检查了几个禁食间隔（12 小时、24 小时、36 小时、48 小时、60 小时、72 小时）。在每个禁食间隔中，我们比较了禁食指定时间的患者与禁食相同时间的患者中低磷血症的发生率。在每个禁食间隔中，禁食组的低磷血症发生率低于非禁食组。然而，这种差异并不显著。BMI、APACHE2 和 ICU 入院前 LOS 与低磷血症的发展呈负相关。在开始营养支持前 ICU 中禁食长达 72 小时不会影响低磷血症的发生。低磷血症与较低的死亡率相关。
