Impact of serum phosphate changes on in-hospital mortality
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RESEARCH ARTICLE
Open Access
Impact of serum phosphate changes on inhospital mortality Charat Thongprayoon1, Wisit Cheungpasitporn2, Panupong Hansrivijit3, Sorkko Thirunavukkarasu1, Api Chewcharat1, Juan Medaura2, Michael A. Mao4 and Kianoush B. Kashani1,5*
Abstract Background: Fluctuations in serum phosphate levels increased mortality in end-stage renal disease patients. However, the impacts of serum phosphate changes in hospitalized patients remain unclear. This study aimed to test the hypothesis that serum phosphate changes during hospitalization were associated with in-hospital mortality. Methods: We included all adult hospitalized patients from January 2009 to December 2013 that had at least two serum phosphate measurements during their hospitalization. We categorized in-hospital serum phosphate changes, defined as the absolute difference between the maximum and minimum serum phosphate, into 5 groups: 0–0.6, 0.7–1.3, 1.4–2.0, 2.1–2.7, ≥2.8 mg/dL. Using serum phosphate change group of 0–0.6 mg/dL as the reference group, the adjusted odds ratio of in-hospital mortality for various serum phosphate change groups was obtained by multivariable logistic regression analysis. Results: A total of 28,149 patients were studied. The in-hospital mortality in patients with serum phosphate changes of 0–0.6, 0.7–1.3, 1.4–2.0, 2.1–2.7, ≥2.8 mg/dL was 1.5, 2.0, 3.1, 4.4, and 10.7%, respectively (p < 0.001). When adjusted for confounding factors, larger serum phosphate changes were associated with progressively increased inhospital mortality with odds ratios of 1.35 (95% 1.04–1.74) in 0.7–1.3 mg/dL, 1.98 (95% CI 1.53–2.55) in 1.4–2.0 mg/ dL, 2.68 (95% CI 2.07–3.48) in 2.1–2.7 mg/dL, and 5.04 (95% CI 3.94–6.45) in ≥2.8 mg/dL compared to serum phosphate change group of 0–0.6 mg/dL. A similar result was noted when we further adjusted for either the admission or mean serum phosphate during hospitalization. Conclusion: Greater serum phosphate changes were progressively associated with increased in-hospital mortality. Keywords: Phosphate, Electrolytes, Hypophosphatemia, Hyperphosphatemia, Mortality
Background Phosphate is an essential element for calciumphosphate-parathyroid homeostasis, which plays an essential role in many cellular metabolisms [1–3]. Serum phosphate levels have been identified as strong predictors on clinical outcomes, including hospital mortality [4]. While hypophosphatemia is shown to be * Correspondence: [email protected] 1 Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA 5 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA Full list of author information is available at the end of the article
independently associated with increased mortality among critically ill patients, malnourished individuals, and patients with sepsis [5–7], hyperphosphatemia is associated with poor clinical outcomes including mortality in chronic kidney disease (CKD) [8, 9], hemodialysis [10, 11], acute c
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