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Hyperphosphatemia is associated with high mortality in severe burns
George Kuo1, Cheng-Chia Lee1, Shih-Yi Yang2
1Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan.
Plos One
|January 10, 2018
Summary
Hyperphosphatemia, a sign of severe tissue damage, is linked to increased mortality in burn patients. This finding highlights the importance of monitoring phosphate levels in severe burn care.
Area of Science:
- Biochemistry
- Critical Care Medicine
- Burn Injury
Background:
- Phosphate levels are frequently abnormal in acute illness, irrespective of kidney injury.
- While hypophosphatemia's impact on burn patient outcomes is documented, hyperphosphatemia's association with mortality remains less explored.
- Hyperphosphatemia may indicate severe tissue damage or kidney injury in critically ill patients.
Purpose of the Study:
- To investigate the association between baseline hyperphosphatemia and 90-day mortality in patients with severe burns.
- To identify hyperphosphatemia as a potential predictor of mortality in severe burn cases.
Main Methods:
- A post hoc analysis of prospectively collected data from 301 severe burn patients admitted between 2006 and 2011.
- Patients were categorized into normophosphatemic and hyperphosphatemic groups based on initial plasma phosphate levels.
- Ninety-day mortality was the primary endpoint, with multivariable Cox analysis used to adjust for confounding factors.
Main Results:
- The hyperphosphatemic group (n=52) exhibited significantly higher 90-day mortality (53.8%) compared to the normophosphatemic group (n=249, 18.1%; P < .001).
- Hyperphosphatemic patients presented with indicators of greater severity, including higher burn size (TBSA), APACHE II and ABSI scores, and increased incidence of acute kidney injury (AKI).
- Multivariable analysis confirmed hyperphosphatemia as an independent risk factor for mortality, alongside burn TBSA, reduced urine output, and APACHE II score.
Conclusions:
- Baseline hyperphosphatemia is significantly associated with increased 90-day mortality in patients with severe burns.
- This association persists even after adjusting for other critical factors like burn severity and kidney function.
- Hyperphosphatemia should be considered a significant predictor of mortality in severe burn management, alongside TBSA and inhalation injury.
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