Clinical Research On Early Hypophosphatemia In Critically Ill Patients

Objective: To investigate the risk factors associated with hypophosphatemia in critically ill patients and evaluate its impact on prognosis.Methods: By retrospective analysis,145 critically ill patients admitted to the medical intensive care unit(ICU)of our hospital between January 2019 and December 2019 were included in the study.(1)Collect the clinical information of patients:demographical data(gender,age and BMI),principal diagnosis,underlying diseases,laboratory indexes(serum phosphorus,C-reactive protein,white blood cells,lymphocytes,serum albumin,serum prealbumin,serum calcium,serum potassium,serum lactate)and severity scores of diseases(APACHE II,SOFA).According to the level of serum phosphorus,the patients were first divided into two groups:non-hypophosphatemia group(n=64)and hypophosphatemia group(n=81).And then the hypophosphatemia group was further divided into mild(n=46)and severe group(n=35).Compare the difference of above indexes between the non-hypophosphatemia group and the hypophosphatemia group.Multivariate logistic regression was used to analyze the risk factors for hypophosphatemia among ICU patients.(2)Compare the difference of above indexes between the mild and severe hypophosphatemia group.(3)Collect the prognosis indicators of patients: the percentage of mechanical ventilation,the duration of mechanical ventilation,length of ICU-stay,the survival status 28 days after admission into ICU.Compare the difference of prognostic indicators among the non-hypophosphatemia group,the mild and severe hypophosphatemia group.(4)According to the survival status 28 days after admission into ICU,the patients were divided into the survival(n=115)and the deceased groups(n=30).Compare the difference of clinical information and prognostic indicators individually between the survival and the deceased groups.Results:(1)Among the 145 patients,81 patients were diagnosed as hypophosphatemia,the incidence of which was 55.86%.Among the hypophosphatemia group,46 patients were diagnosed as mild hypophosphatemia(31.71%)and 35 patients as severe hypophosphatemia(24.13%).(2)The levels of serum CRP and APACHE Ⅱ scores in the hypophosphatemia group were higher than those in the non-hypophosphatemia group,while the levels of serum albumin and prealbumin were lower(P<0.05).(3)By multivariate logistic regression,high APACHE II score was a risk factor for the incidence of hypophosphatemia(OR=1.118,95%CI=1.012-1.235,P=0.027),while high serum prealbumin was a protective factor(OR=0.960,95%CI=0.944-0.976,P<0.001).(4)The percentage of sepsis,the levels of APACHE Ⅱ scores and SOFA scores in the severe hypophosphatemia group were higher than those in the mild hypophosphatemia group,while the levels of serum albumin and prealbumin were lower(P<0.05).(5)The level of APACHE Ⅱ scores in the mild hypophosphatemia group was higher than that in the non-hypophosphatemia group(P<0.05).The level of APACHE Ⅱ scores,the percentage of mechanical ventilation,the duration of mechanical ventilation,the length of ICU-stay and the 28-day mortality were higher in the severe hypophosphatemia group than those either in the non-hypophosphatemia group or in the mild hypophosphatemia group(P<0.05).(6)The percentage of sepsis,the levels of CRP,WBC,blood lactate,APACHE Ⅱ scores,SOFA scores,the percentage of mechanical ventilation,the duration of mechanical ventilation,the length of ICU-stay in the deceased group were higher than those in the survival group,while the levels of serum phosphorus,serum albumin and serum prealbumin were lower(P<0.05).Conclusion:(1)The incidence of hypophosphatemia is high in critically ill patients.(2)High APACHE II score might be a risk factor for hypophosphatemia,while high serum prealbumin might be a protective factor.(3)Hypophosphatemia might be an indicator to evaluate the severity of diseases for critically ill patients.The lower serum phosphorus,the worse prognosis.