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Moderate to severe hyperphosphataemia as an independent prognostic factor for 28-day mortality in adult patients with sepsis
  1. Dong-Hyun Jang1,
  2. You Hwan Jo1,2,
  3. Jae Hyuk Lee1,
  4. Joonghee Kim1,
  5. Seung Min Park1,
  6. Ji Eun Hwang1,
  7. Dong Keon Lee1,
  8. Inwon Park1,
  9. Che Uk Lee1,
  10. Sang-Min Lee1
  1. 1 Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, The Republic of Korea
  2. 2 Emergency Medicine, Seoul National University College of Medicine, Seoul, The Republic of Korea
  1. Correspondence to Dr You Hwan Jo, Emergency medicine, Seoul National University Bundang Hospital, Seongnam 13620, the Republic of Korea; emdrjyh{at}


Background Ischaemic tissue injury caused by tissue hypoperfusion is one of the major consequences of sepsis. Phosphate concentrations are elevated in ischaemic tissue injury. This study was performed to investigate the association of phosphate concentrations with mortality in patients with sepsis.

Methods This was a retrospective cohort study of patients with sepsis conducted at an urban, tertiary care emergency department (ED) in Korea. Patients with sepsis arriving between March 2010 and April 2017 were stratified into four groups according to the initial phosphate concentration at presentation to the ED: group I (hypophosphataemia, phosphate <2 mg/dL), group II (normophosphataemia, phosphate 2–4 mg/dL), group III (mild hyperphosphataemia, phosphate 4–6 mg/dL), group IV (moderate to severe hyperphosphataemia, phosphate ≥6 mg/dL). Multivariable Cox proportional hazard regression analyses were performed to evaluate the independent association of initial phosphate concentration with 28-day mortality.

Results Of the 3034 participants in the study, the overall mortality rate was 21.9%. The 28-day mortality rates were group I (hypophosphataemia) 14.6%, group II 17.4% (normophosphataemia), group III (mild hyperphosphataemia) 29.2% and group IV (moderate to severe hyperphosphataemia) 51.4%, respectively (p<0.001). In the multivariable analyses, patients with severe hyperphosphataemia had a significantly higher risk of death than those with normal phosphate levels (HR 1.59; 95% CI 1.23 to 2.05). Mortality in the other groups was not significantly different from mortality in patients with normophosphataemia.

Conclusions Moderate to severe hyperphosphataemia was associated with 28-day mortality in patients with sepsis. Phosphate level could be used as a prognostic indicator in sepsis.

  • infection
  • death/mortality
  • emergency department
  • intensive care

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  • Contributors YHJ, JHL and JK conceived and design the study. D-HJ, DKL and CUL conduct data analysis. JK and JEH provide statistical advice. D-HJ, IP and S-ML drafted the manuscript. YHJ and SMP contributed to its revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by institutional review board of Seoul National University Bundang Hospital. (Approval number: B-1908/556-103).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Only deidentified participant data are available on reasonable request to the corresponding author.