Wang Jun, Song Xiao-Hua, Shi Shi-Yang, Chen Lu, Jiang Li, Ding Sheng, Gao Feng
ICU, Department of Cardiovascular Surgery, People's Liberation Army The General Hospital of Western Theater Command, Chengdu, 610083, Sichuan, China.
Sci Rep. 2025 Feb 25;15(1):6813. doi: 10.1038/s41598-025-90531-0.
Serum phosphate levels are strongly correlated with the prognosis of septic patients. However, previous studies have concentrated on individual phosphate levels, and the relationship between change trends in serum phosphate levels and in-hospital mortality has seldom been reported. We aimed to investigate whether the level and change trends of serum phosphate were associated with in-hospital mortality. We classified patients using k-means clustering analysis into clusters with changes in serum phosphate levels and used logistic regressions to explore the relationships between different clusters and in-hospital mortality, taking the cluster with the smallest change as a reference. Restricted cubic spline regression was used to examine the shape of the correlation between changes in serum phosphate levels and in-hospital mortality. Subgroup analyses and interaction analyses were performed to discover potential impact factors. A total of 1810 (21.1%) of 8586 participants died during their hospital stay. After adjustment for baseline variables, cluster 2 (OR 1.303, 95% CI 1.101-1.542, p = 0.002), cluster 3 (OR 1.348, 95% CI 1.158-1.57, p < 0.001), cluster 4 (OR 1.652, 95% CI 1.225-2.222, p = 0.001) and cluster 5 (OR 2.745, 95% CI 2.212-3.407, p < 0.001) remained associated with significantly increased mortality. The changes in serum phosphate levels and in-hospital mortality were linear according to restricted cubic spline regression. According to the subgroup analyses, the ORs of the female subgroup and mechanical ventilation subgroup were lower than those of their counterparts across all clusters. Multiplicative and additive interactions were detected between phosphate clusters and mechanical ventilation. First, a high and unstable serum phosphate level is associated with increased mortality in septic patients. Second, for those with elevated phosphate levels, treatments to lower serum phosphate may reduce mortality in septic patients. Third, an increasing trend in phosphate levels may be more important than a high level in predicting poor prognosis in septic patients.
血清磷酸盐水平与脓毒症患者的预后密切相关。然而，以往的研究主要集中在个体磷酸盐水平上，血清磷酸盐水平变化趋势与院内死亡率之间的关系鲜有报道。我们旨在研究血清磷酸盐水平及其变化趋势是否与院内死亡率相关。我们使用k均值聚类分析将患者按照血清磷酸盐水平变化分为不同类别，并采用逻辑回归分析，以变化最小的类别作为参照，探究不同类别与院内死亡率之间的关系。使用受限立方样条回归分析来检验血清磷酸盐水平变化与院内死亡率之间的相关性形状。进行亚组分析和交互分析以发现潜在影响因素。8586名参与者中有1810名（21.1%）在住院期间死亡。在对基线变量进行调整后，第2组（比值比1.303，95%置信区间1.101 - 1.542，p = 0.002）、第3组（比值比1.348，95%置信区间1.158 - 1.57，p < 0.001）、第4组（比值比1.652，95%置信区间1.225 - 2.222，p = 0.001）和第5组（比值比2.745，95%置信区间2.212 - 3.407，p < 0.001）仍与死亡率显著增加相关。根据受限立方样条回归分析，血清磷酸盐水平变化与院内死亡率呈线性关系。根据亚组分析，女性亚组和机械通气亚组在所有类别中的比值比均低于相应对照组。在磷酸盐类别与机械通气之间检测到相乘和相加交互作用。第一，血清磷酸盐水平高且不稳定与脓毒症患者死亡率增加相关。第二，对于磷酸盐水平升高的患者，降低血清磷酸盐的治疗可能降低脓毒症患者的死亡率。第三，在预测脓毒症患者预后不良方面，磷酸盐水平的上升趋势可能比高水平更为重要。
