Frontiers in medicine · 2026
Hypophosphatemia-factors associated with its development and 90-day mortality effect: a prospective observational study.
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Statlender Liran, Shochat Tzippy, Rozilyo Limor, Cherny Izhack, Amer Jumana, Halperin Guy, Robinson Eyal, Itzhaki Moran Hellerman, Bendavid Itai, Fishman Guy, Singer Pierre, Kagan Ilya
Аннотация
BACKGROUND: Several factors are associated with hypophosphatemia. There is a paucity of data regarding the effects of restrictive energy delivery and phosphate renal handling with hypophosphatemia in the critically ill patient.
METHODS: This is a single-center observational study. Patients were included if they were admitted ventilated and their ICU stay was at least 48 h. Baseline characteristics were recorded upon admission; other variables were collected daily during the first five admission days: SOFA1 score, serum phosphate, energy delivery, phosphate delivery and fluid balance. A 6-h urine collection for phosphate and creatinine was performed daily. Creatinine clearance (CrCl6hr), tubular reabsorption of phosphate (TRP), and tubular maximal reabsorption rate of phosphate adjusted to the glomerular filtration rate (TmP/GFR) were calculated. Mortality follow up time was 90 days. A comparison was made between patients who developed hypophosphatemia (serum phosphate < 2.5 mg/dl), and those who did not. Univariate and multivariate regressions for hypophosphatemia and for 90-day mortality were performed.
RESULTS: One hundred eighty-one patients were included in the analysis. One hundred and nine (60.22%) developed hypophosphatemia. They were younger, had lower APACHE2 score, and were admitted more frequently due to trauma. No association of energy delivery with hypophosphatemia was found. In a multivariate analysis only log of CrCl6hr and TmP/GFR were associated with hypophosphatemia. Hypophosphatemia was associated with 90-d mortality in univariate analysis, but not in multivariate analysis.
CONCLUSION: Creatinine clearance based on a 6-h urine collection and TmP/GFR were associated with hypophosphatemia, whereas energy delivery was not. Age and APACHE2 were associated with 90-d mortality, but hypophosphatemia was not.
METHODS: This is a single-center observational study. Patients were included if they were admitted ventilated and their ICU stay was at least 48 h. Baseline characteristics were recorded upon admission; other variables were collected daily during the first five admission days: SOFA1 score, serum phosphate, energy delivery, phosphate delivery and fluid balance. A 6-h urine collection for phosphate and creatinine was performed daily. Creatinine clearance (CrCl6hr), tubular reabsorption of phosphate (TRP), and tubular maximal reabsorption rate of phosphate adjusted to the glomerular filtration rate (TmP/GFR) were calculated. Mortality follow up time was 90 days. A comparison was made between patients who developed hypophosphatemia (serum phosphate < 2.5 mg/dl), and those who did not. Univariate and multivariate regressions for hypophosphatemia and for 90-day mortality were performed.
RESULTS: One hundred eighty-one patients were included in the analysis. One hundred and nine (60.22%) developed hypophosphatemia. They were younger, had lower APACHE2 score, and were admitted more frequently due to trauma. No association of energy delivery with hypophosphatemia was found. In a multivariate analysis only log of CrCl6hr and TmP/GFR were associated with hypophosphatemia. Hypophosphatemia was associated with 90-d mortality in univariate analysis, but not in multivariate analysis.
CONCLUSION: Creatinine clearance based on a 6-h urine collection and TmP/GFR were associated with hypophosphatemia, whereas energy delivery was not. Age and APACHE2 were associated with 90-d mortality, but hypophosphatemia was not.