脓毒症患者血清磷水平变化轨迹对28天死亡风险的影响：一项来自MIMIC-IV数据库的回顾性队列研究
Effect of changes trajectory of serum phosphate levels on the 28-day mortality risk in patients with sepsis: a retrospective cohort study from the MIMIC-IV database.
作者信息
Zhang Rui, Zhou Dingxing
机构信息
Department of Emergency, Wuxi No.2 Chinese Medicine Hospital, No. 390 Xincheng Road, Binhu District, Wuxi, 214121, Jiangsu, P.R. China.
出版信息
BMC Infect Dis. 2025 Feb 21;25(1):245. doi: 10.1186/s12879-025-10547-9.
BACKGROUND
Serum phosphate levels have been reported to be linked to the prognosis in critically ill patients. The purpose of this study was to analyze the impact of the trajectory of changes in serum phosphate levels on the short-term mortality risk in patients with sepsis.
METHODS
This retrospective cohort study used data on patients with sepsis from the 2008-2019 Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Serum phosphate level trajectories were constructed using a latent growth mixture modeling (LGMM) based on four measurements of serum phosphate at six-hour intervals within 24 h of admission to the intensive care unit (ICU). The relationship between serum phosphate levels at ICU admission and serum phosphate level trajectories and the risk of 28-day mortality in patients with sepsis was analyzed using Cox regression models, and hazard ratio (HR) and 95% confidence interval (CI) were calculated.
RESULTS
Of these 1,703 patients with sepsis included, 566 (33.24%) died within 28 days. The median serum phosphate levels of the patients were 4.10 (3.00, 5.50) mg/dL. Four serum phosphate level trajectories were classified: normal-level-steady trend (trajectory 1), high-level-steady trend (trajectory 2), high-level-decreasing trend (trajectory 3), and high-level-increasing trend (trajectory 4). High serum phosphate levels at admission were associated with a higher risk of 28-day mortality (HR = 1.05, 95%CI: 1.01-1.09) in patients with sepsis. For trajectories, trajectory 2 (HR = 1.27, 95%CI: 1.05-1.54) related to an increased risk of 28-day mortality compared with trajectory 1, whereas trajectory 4 (HR = 1.69, 95%CI: 0.99-2.91, P = 0.056) may be related. There was no significant difference in 28-day mortality between patients on trajectory 3 and trajectory 1 (P = 0.280). Subgroup analyses demonstrated that patients with trajectory 2 were linked to a higher risk of 28-day mortality in different population subgroups (P < 0.05).
CONCLUSION
Stable trajectories of high serum phosphate levels are an important risk factor for short-term mortality in patients with sepsis.
背景
据报道，血清磷酸盐水平与危重症患者的预后相关。本研究旨在分析血清磷酸盐水平变化轨迹对脓毒症患者短期死亡风险的影响。
方法
这项回顾性队列研究使用了2008 - 2019年重症监护医学信息集市IV（MIMIC-IV）数据库中脓毒症患者的数据。血清磷酸盐水平轨迹是基于重症监护病房（ICU）入院后24小时内每隔6小时进行的四次血清磷酸盐测量，采用潜在增长混合模型（LGMM）构建的。使用Cox回归模型分析ICU入院时的血清磷酸盐水平和血清磷酸盐水平轨迹与脓毒症患者28天死亡风险之间的关系，并计算风险比（HR）和95%置信区间（CI）。
结果
在纳入的这1703例脓毒症患者中，566例（33.24%）在28天内死亡。患者的血清磷酸盐水平中位数为4.10（3.00，5.50）mg/dL。血清磷酸盐水平轨迹分为四类：正常水平稳定趋势（轨迹1）、高水平稳定趋势（轨迹2）、高水平下降趋势（轨迹3）和高水平上升趋势（轨迹4）。入院时血清磷酸盐水平高与脓毒症患者28天死亡风险较高相关（HR = 1.05，95%CI：1.01 - 1.09）。对于轨迹，与轨迹1相比，轨迹2（HR = 1.27，95%CI：1.05 - 1.54）与28天死亡风险增加相关，而轨迹4（HR = 1.69，95%CI：0.99 - 2.91，P = 0.056）可能相关。轨迹3和轨迹1的患者28天死亡率无显著差异（P = 0.280）。亚组分析表明，在不同人群亚组中，轨迹2的患者与28天死亡风险较高相关（P < 0.05）。
结论
高血清磷酸盐水平的稳定轨迹是脓毒症患者短期死亡的重要危险因素。
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