Serum inorganic phosphorus levels predict 30-day mortality in patients with community acquired pneumonia
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Published on: June 10, 2025
Mohammad E Naffaa1,2,3, Mona Mustafa4, Mohje Azzam5
1Department of Internal Medicine H, Rambam Health Care Campus, Haifa, Israel. m_naffaa@rambam.health.gov.il.
Insights
Serum phosphorus levels on admission significantly impact outcomes for community-acquired pneumonia (CAP) patients. Abnormal phosphorus, both low and high, is linked to increased 30-day mortality in CAP cases.
Area of Science:
- Medical Research
- Clinical Medicine
- Pulmonology
Background:
- Community-acquired pneumonia (CAP) is a significant cause of illness and death.
- The relationship between initial serum phosphorus levels and CAP patient outcomes requires further investigation.
Purpose of the Study:
- To examine the prognostic significance of admission serum phosphorus levels on 30-day mortality in CAP patients.
Main Methods:
- Retrospective analysis of 3894 adult patients diagnosed with CAP between 2006 and 2012.
- Binary logistic regression was employed to calculate odds ratios (OR) and p-values for risk factors associated with 30-day mortality.
Main Results:
- Abnormal phosphorus levels (<1.5 mg/dl or >4.5 mg/dl) were significantly associated with increased 30-day mortality (38% and 39% excess risk, respectively).
- Phosphorus levels within the upper normal range (4-4.5 mg/dl) also showed higher mortality (24% excess risk) compared to the reference group (1.5-3.5 mg/dl).
- Other risk factors included advanced age, elevated CURB-65 score, high RDW, hypernatremia, and hypoalbuminemia.
Conclusions:
- Abnormal serum phosphorus levels upon hospital admission are a significant predictor of increased mortality in patients with community-acquired pneumonia.
Background:
Community acquired pneumonia is a major cause of morbidity and mortality. The association between serum phosphorus levels on admission and the outcome of patients with community acquired pneumonia has not been widely examined. We aimed to investigate the prognostic value of serum phosphorus levels on admission on the 30- day mortality.
Methods:
The cohort included patients of 18 years old or older who were diagnosed with community acquired pneumonia between 2006 and 2012. Patients were retrospectively analyzed to identify risk factors for a primary endpoint of 30-day mortality. Binary logistic regression analysis was used for the calculation of the odds ratios (OR) and p values in bivariate and multivariate analysis to identify association between patients' characteristic and 30-day mortality.
Results:
The cohort included 3894 patients. In multivariate regression analysis, variables associated with increased risk of 30-day mortality included: age >80 years, increased CURB-65 score, RDW >15, hypernatremia >150 mmol/l, hypoalbuminemia <2 gr/dl and abnormal levels of phosphorus. Levels of <1.5 mg/dl and >4.5 mg/dl were significantly associated with excess 30-day mortality, 38 % (OR 2.9, CI 1.8-4.9, P = 0.001) and 39 % (OR 3.4, CI 2.7-4.2, P = 0.001), respectively. Phosphorus levels within the upper normal limits (4-4.5 mg/dl) were associated with higher mortality rates compared to levels between 1.5-3.5 mg/dl, the reference group, 24 % (OR 1.9, CI 1.5-2.4, P = 0.001).
Conclusions:
Abnormal phosphorus levels on admission are associated with increased mortality rates among patients hospitalized with Community acquired pneumonia.
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