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Epidemiology of hypophosphatemia in critical illness: A multicentre, retrospective cohort study.
Attokaran, Antony George; White, Kyle C; Doola, Ra'eesa; McIlroy, Philippa; Senthuran, Siva; Luke, Stephen; Garrett, Peter; Tabah, Alexis; Shekar, Kiran; Edwards, Felicity; White, Hayden; McCullough, James Pa; Hurford, Rod; Clement, Pierre; Laupland, Kevin B; Ramanan, Mahesh.
Afiliação
  • Attokaran AG; Intensive Care Unit, Rockhampton Hospital, Rockhampton, Queensland, Australia; University of Queensland, Rural Clinical School, Rockhampton, Queensland, Australia. Electronic address: antony.attokaran@health.qld.gov.au.
  • White KC; Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
  • Doola R; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Centre for Functioning and Health Research, Metro South Health, Queensland, Australia; Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
  • McIlroy P; Intensive Care Unit, Cairns Hospital, Cairns, Queensland, Australia.
  • Senthuran S; Intensive Care Unit, Townsville Hospital, Townsville, Queensland, Australia; College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
  • Luke S; Intensive Care Services, Mackay Base Hospital, Mackay, Queensland, Australia.
  • Garrett P; Intensive Care Unit, Sunshine Coast University Hospital, Birtinya, Queensland, Australia; School of Medicine and Dentistry, Griffith University, Mount Gravatt, Queensland, Australia.
  • Tabah A; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Intensive Care Unit, Redcliffe Hospital, Brisbane, Queensland, Australia; Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
  • Shekar K; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Adult Intensive Care Services, the Prince Charles Hospital, Brisbane, Queensland, Australia.
  • Edwards F; Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
  • White H; School of Medicine and Dentistry, Griffith University, Mount Gravatt, Queensland, Australia; Intensive Care Unit, Logan Hospital, Logan, Queensland, Australia.
  • McCullough JP; Intensive Care Unit, Gold Coast University Hospital, Southport, Queensland, Australia.
  • Hurford R; Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
  • Clement P; Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
  • Laupland KB; Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
  • Ramanan M; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Adult Intensive Care Services, the Prince Charles Hospital, Brisbane, Queensland, Australia; Intensive Care Unit, Caboolture Hospital, Caboolture, Queensland, Australia; Critical Care Division, The George Institute for G
Anaesth Crit Care Pain Med ; 43(5): 101410, 2024 Oct.
Article em En | MEDLINE | ID: mdl-39089453
ABSTRACT

INTRODUCTION:

Hypophosphatemia is common in critically ill patients. We have described the epidemiology of hypophosphatemia in patients admitted to the Intensive Care Units.

METHODS:

A multicentre, retrospective cohort study of 12 ICUs in Queensland, Australia from January 1st, 2015, to December 31st, 2021. Exclusions included readmissions, renal replacement therapy, end-stage renal disease, and palliative intent admissions and transfers from other ICUs. Patients were classified into four groups based on the severity of the first episode of low serum phosphate (PO4) "None" (PO4 ≥0.81 mmol/L, "Mild" (PO4 ≥0.50 & <0.81 mmol/L) "Moderate" (PO4 ≥0.30 & <0.50 mmol/L) and "Severe" (PO4 <0.30 mmol/L). A mixed-effect logistic regression model, including hospital as a random effect, was developed to examine factors associated with 90-day case fatality.

RESULTS:

Of the 89,776 patients admitted, 68,699 patients were included in this study, with 23,485 (34.2%) having hypophosphatemia with onset mostly on Day 2 of ICU admission and correcting to normal 3 days after hypophosphatemia was identified. There was substantial variation among participating ICUs in phosphate replacement; the threshold, and the route by which it was replaced. Day-90 case fatality increased with severity of hypophosphatemia (None 3974 (8.8%), Mild 2306 (11%), Moderate 377 (14%); Severe 108 (21%) (p < 0.001)). Multivariable regression analysis showed that compared to those without hypophosphatemia, patients with moderate (odds ratio (OR) 1.24; 95% confidence intervals (CI) 1.07-1.44; p = 0.004) or severe (OR 1.49; 95% CI 1.13-1.97; p = 0.005) hypophosphatemia had increased risk of 90-day case fatality.

CONCLUSION:

Hypophosphatemia was common, and mostly occurred on day 2 with early correction of serum phosphate. Phosphate replacement practices were variable among ICUs. Moderate and severe hypophosphatemia was associated with increased 90-day case fatality.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Estado Terminal / Hipofosfatemia / Unidades de Terapia Intensiva Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: Oceania Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Estado Terminal / Hipofosfatemia / Unidades de Terapia Intensiva Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: Oceania Idioma: En Ano de publicação: 2024 Tipo de documento: Article