Serum Phosphate Levels may Predict Mortality Rate in Pediatric Intensive Care Units: Study
A recent study published in the journal BMJ Pediatrics Open found both very low and very high serum phosphate levels are associated with increased mortality rates in pediatric intensive care units.
Mortality rates in intensive care units (ICUs) are vital deciding factors for better healthcare quality and patient prognosis. Phosphate is an essential intracellular ion crucial to the body’s physiological processes. Previous research showed an association between abnormal phosphate levels and morbidity and mortality levels in severely sick patients. Hyper and hypophosphatemia have been linked to poor prognosis in individuals in ICUs. However, there is ambiguity about the association of serum phosphate levels in pediatric ICUs (PICUs). Hence, researchers from Children’s Hospital, Zhejiang University School of Medicine, China, conducted a study to examine the link between phosphate levels and 30-day mortality during PICU hospitalization.
A retrospective cohort study collected information from 12,881 PICU patients at the Children’s Hospital, Zhejiang University, School of Medicine, China. The study was carried out for 8 years, from 2010 to 2018. The observation period was from admission to 30 days of hospitalization. The primary outcome of measurement was 30 days of admission. Patients over 28 days old and < 18 years of age were included in the study. Multifactorial logistic regression analyses were used. Phosphate levels were analyzed as continuous, categorical, and trend variables to verify the stability
Findings:
- A significant positive relationship was found between phosphate and 30-day PICU mortality using a multiple linear regression model.
- The generalized additive models found a non-linear association between serum phosphate and 30-day PICU mortality.
- The critical point for serum phosphate concentration was 1.2mmol/L, as found in the two-phase linear regression analysis.
- Serum phosphate levels were inversely correlated to the left of this critical point, and a positive relation was found to the right.
Thus, the study concluded that serum phosphate levels were linked to the 30-day mortality rate during PICU hospitalization. Both hyper and hypophosphate levels were linked to an increased risk of death in the PICU. The study underscores the significant implications of serum phosphates in the PICU for clinical decision-making. Routine monitoring of the phosphate levels is essential during PICU stay to identify pediatric patients at risk.
Pediatric patients with phosphate levels above or below 1.2mmol/L should be closely monitored. The study also shows that maintaining the phosphate levels within the optimal range reduces the mortality risk. The study underscores the importance of using phosphate levels to predict outcomes and prioritize based on serum phosphate levels.
Further reading: Ding Y, Lei Y, Zhu Y, Zhang H, Xiao Y. Association between phosphate and 30-day in-hospital mortality in paediatric ICU: a retrospective cohort study. BMJ Paediatr Open. 2024;8(1):e003171. Published 2024 Dec 31. doi:10.1136/bmjpo-2024-003171.
