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Impact of Serum Phosphate in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock.
J Intensive Care Med. 2020 May; 35(5):485-493.JI

Abstract

BACKGROUND

Hypo- and hyperphosphatemia are common in severe sepsis and septic shock. Published outcome data in patients with phosphate derangements primarily focus on hypophosphatemia and the general critically ill population. This study aimed to determine the impact of serum phosphate on clinical outcomes in patients with severe sepsis and septic shock.

METHODS

A retrospective cohort analysis of adult mechanically ventilated patients with severe sepsis or septic shock was performed. Patients were randomly selected from an internal intensive care unit (ICU) database at an academic medical center in the United States and screened for inclusion and exclusion criteria. Time-weighted phosphate was calculated using all phosphate measurements obtained during ICU admission. The associations between time-weighted phosphate and duration of mechanical ventilation, 28-day mortality, and ICU and hospital length of stay were evaluated using linear or logistic regression as appropriate.

RESULTS

One-hundred ninety-seven patients were evaluated: 33 were categorized as hypophosphatemia, 123 as normophosphatemia, and 41 as hyperphosphatemia. Patients with time-weighted hyperphosphatemia had a higher Simplified Acute Physiology Score III score and incidence of septic shock. Significantly higher rates of 28-day mortality were observed among those with time-weighted phosphate levels above 3.5 mg/dL. However, both time-weighted hypo- and hyperphosphatemia were associated with decreased duration of mechanical ventilation. For every 0.5 mg/dL increase in time-weighted phosphate referent values from 4.0 to 6.0, the duration of mechanical ventilation decreased by 8% to 26%. For every 0.5 mg/dL decrease in time-weighted phosphate referent values from 3.0 to 1.0, significant decreases in duration of mechanical ventilation ranged from 14% to 41%.

CONCLUSION

Time-weighted hyperphosphatemia may be associated with increased mortality in mechanically ventilated patients with severe sepsis or septic shock. However, time-weighted hypo- and hyperphosphatemia were associated with decreased duration of mechanical ventilation. Future studies should further describe the impact of hypo- and hyperphosphatemia on clinical outcomes among critically ill patients with severe sepsis or septic shock.

Authors+Show Affiliations

Department of Pharmacy, University of Colorado Hospital, Aurora, CO, USA.Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.Center for Biostatistics, The Ohio State University, Columbus, OH, USA.Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

Pub Type(s)

Evaluation Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

29519205

Citation

Miller, Christopher J., et al. "Impact of Serum Phosphate in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock." Journal of Intensive Care Medicine, vol. 35, no. 5, 2020, pp. 485-493.
Miller CJ, Doepker BA, Springer AN, et al. Impact of Serum Phosphate in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock. J Intensive Care Med. 2020;35(5):485-493.
Miller, C. J., Doepker, B. A., Springer, A. N., Exline, M. C., Phillips, G., & Murphy, C. V. (2020). Impact of Serum Phosphate in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock. Journal of Intensive Care Medicine, 35(5), 485-493. https://doi.org/10.1177/0885066618762753
Miller CJ, et al. Impact of Serum Phosphate in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock. J Intensive Care Med. 2020;35(5):485-493. PubMed PMID: 29519205.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of Serum Phosphate in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock. AU - Miller,Christopher J, AU - Doepker,Bruce A, AU - Springer,Andrew N, AU - Exline,Matthew C, AU - Phillips,Gary, AU - Murphy,Claire V, Y1 - 2018/03/08/ PY - 2018/3/10/pubmed PY - 2021/1/5/medline PY - 2018/3/10/entrez KW - hyperphosphatemia KW - hypophosphatemia KW - mechanical ventilation KW - septic shock KW - severe sepsis SP - 485 EP - 493 JF - Journal of intensive care medicine JO - J Intensive Care Med VL - 35 IS - 5 N2 - BACKGROUND: Hypo- and hyperphosphatemia are common in severe sepsis and septic shock. Published outcome data in patients with phosphate derangements primarily focus on hypophosphatemia and the general critically ill population. This study aimed to determine the impact of serum phosphate on clinical outcomes in patients with severe sepsis and septic shock. METHODS: A retrospective cohort analysis of adult mechanically ventilated patients with severe sepsis or septic shock was performed. Patients were randomly selected from an internal intensive care unit (ICU) database at an academic medical center in the United States and screened for inclusion and exclusion criteria. Time-weighted phosphate was calculated using all phosphate measurements obtained during ICU admission. The associations between time-weighted phosphate and duration of mechanical ventilation, 28-day mortality, and ICU and hospital length of stay were evaluated using linear or logistic regression as appropriate. RESULTS: One-hundred ninety-seven patients were evaluated: 33 were categorized as hypophosphatemia, 123 as normophosphatemia, and 41 as hyperphosphatemia. Patients with time-weighted hyperphosphatemia had a higher Simplified Acute Physiology Score III score and incidence of septic shock. Significantly higher rates of 28-day mortality were observed among those with time-weighted phosphate levels above 3.5 mg/dL. However, both time-weighted hypo- and hyperphosphatemia were associated with decreased duration of mechanical ventilation. For every 0.5 mg/dL increase in time-weighted phosphate referent values from 4.0 to 6.0, the duration of mechanical ventilation decreased by 8% to 26%. For every 0.5 mg/dL decrease in time-weighted phosphate referent values from 3.0 to 1.0, significant decreases in duration of mechanical ventilation ranged from 14% to 41%. CONCLUSION: Time-weighted hyperphosphatemia may be associated with increased mortality in mechanically ventilated patients with severe sepsis or septic shock. However, time-weighted hypo- and hyperphosphatemia were associated with decreased duration of mechanical ventilation. Future studies should further describe the impact of hypo- and hyperphosphatemia on clinical outcomes among critically ill patients with severe sepsis or septic shock. SN - 1525-1489 UR - https://www.unboundmedicine.com/medline/citation/29519205/Impact_of_Serum_Phosphate_in_Mechanically_Ventilated_Patients_With_Severe_Sepsis_and_Septic_Shock_ L2 - https://journals.sagepub.com/doi/10.1177/0885066618762753?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -