PT  - JOURNAL ARTICLE
AU  - Dong-Hyun Jang
AU  - You Hwan Jo
AU  - Jae Hyuk Lee
AU  - Joonghee Kim
AU  - Seung Min Park
AU  - Ji Eun Hwang
AU  - Dong Keon Lee
AU  - Inwon Park
AU  - Che Uk Lee
AU  - Sang-Min Lee
TI  - Moderate to severe hyperphosphataemia as an independent prognostic factor for 28-day mortality in adult patients with sepsis
AID  - 10.1136/emermed-2019-208976
DP  - 2020 Jun 01
TA  - Emergency Medicine Journal
PG  - 355--361
VI  - 37
IP  - 6
4099  - http://emj.bmj.com/content/37/6/355.short
4100  - http://emj.bmj.com/content/37/6/355.full
SO  - Emerg Med J2020 Jun 01; 37
AB  - 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.