Objective 

To explore the impact of early serum phosphate levels on the prognosis of critically ill patients with sepsis.

Methods 

In this retrospective large cohort study, data of patients with sepsis were obtained from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Patients were retrospectively divided into a control group and three study groups according to their daily serum phosphate levels within two days of ICU admission. A Cox regression model was used to evaluate the association between serum phosphate levels and 28-day morbidity.

Results 

This study included 9691 patients diagnosed with sepsis. During the first two days of ICU admission, patients with hyperphosphatemia in either of the two days had higher 28-day mortality, while patients in the hypophosphatemia group had lower 28-day mortality (first day,32.9%vs16.3%; second day, 36.3%vs14.7%). After adjusting for potential confounders, hyperphosphatemia was significantly associated with 28-day mortality; however, only hypophosphatemia on the second day was independently associated with reduced 28-day mortality. After stratification in the hypophosphatemia group, subgroup analysis showed that only the association between the mild hypophosphatemia group and 28-day mortality reached statistical significance (HR = 0.76, 95% CI 0.65 to 0.89, p = 0.001).

Conclusion 

Mild hypophosphatemia might improve the short-term prognosis of patients with sepsis, and hyperphosphatemia is an independent risk factor for the outcomes of septic patients. After ICU admission, the serum phosphate levels on the second day had a better independent correlation with 28-day mortality, which prompted us to reconsider the optimal timing of phosphate evaluation.

中文翻译：

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脓毒症患者早期血磷水平与短期死亡率的关系分析：基于MIMIC-IV的回顾性研究

客观的 

探讨早期血清磷酸盐水平对脓毒症危重患者预后的影响。

方法 

在这项回顾性大型队列研究中，脓毒症患者的数据来自重症监护医学信息市场 (MIMIC)-IV 数据库。根据患者入ICU两天内每日血清磷酸盐水平回顾性地将患者分为对照组和三个研究组。Cox 回归模型用于评估血清磷酸盐水平与 28 天发病率之间的关联。

结果 

这项研究包括 9691 名被诊断患有脓毒症的患者。入ICU前两天，任意两天发生高磷血症的患者28天死亡率较高，而低磷血症组患者28天死亡率较低（第一天，32.9%vs16.3%；第二天，36.3% vs 14.7%）。调整潜在混杂因素后，高磷血症与 28 天死亡率显着相关；然而，只有第二天的低磷血症与 28 天死亡率降低独立相关。对低磷血症组进行分层后，亚组分析显示，只有轻度低磷血症组与28天死亡率之间的相关性达到统计学显着性（HR = 0.76，95% CI 0.65至0.89，p = 0.001）。

结论 

轻度低磷血症可能改善脓毒症患者的短期预后，而高磷血症是脓毒症患者预后的独立危险因素。入住ICU后，第二天的血清磷酸盐水平与28天死亡率具有更好的独立相关性，这促使我们重新考虑磷酸盐评估的最佳时机。