Association between phosphate and 30-day in-hospital mortality in paediatric ICU: a retrospective cohort study
Yiyi Ding1,2, Yaqin Lei2, Yufang Zhu2
1Jinan University, Guangzhou, Guangdong, China.
Insights
Serum phosphate levels impact paediatric intensive care unit (PICU) mortality. Both low and high phosphate levels increase the risk of death within 30 days in PICU patients.
Area of Science:
- Pediatric Critical Care Medicine
- Clinical Chemistry
- Biostatistics
Background:
- Paediatric intensive care unit (PICU) mortality rates are significant.
- Serum phosphate level abnormalities are linked to adverse outcomes in intensive care unit (ICU) patients.
- The association between admission serum phosphate and PICU mortality remains understudied.
Purpose of the Study:
- To investigate the relationship between serum phosphate concentrations upon admission and 30-day mortality in a paediatric intensive care unit (PICU).
Main Methods:
- Retrospective analysis of 12,881 PICU patients from 2010-2018.
- Utilized data from the PIC database.
- Employed multiple linear regression and generalized additive models to assess phosphate-mortality associations.
Main Results:
- A significant positive association was found between serum phosphate and 30-day PICU mortality (OR 1.27).
- A non-linear, U-shaped relationship between serum phosphate and mortality was identified.
- A critical serum phosphate concentration of 1.2 mmol/L was determined, with inverse correlation below and positive correlation above this threshold.
Conclusions:
- Serum phosphate levels exhibit a U-shaped relationship with 30-day mortality in the PICU.
- Both hypophosphataemia (low phosphate) and hyperphosphataemia (high phosphate) are associated with increased mortality risk.
- Admission serum phosphate levels are a significant predictor of mortality in paediatric intensive care.
Background:
Death rates in the intensive care unit (ICU) and paediatric ICU (PICU) are approximately 10.8% and 9.13%, respectively. Serum phosphate irregularities, such as low or high phosphate levels, significantly impact ICU patient outcomes. However, the connection between serum phosphate concentrations on admission and PICU mortality has not been investigated.
Methods:
Information was collected from 12 881 PICU patients at the Children's Hospital, Zhejiang University School of Medicine, over an 8-year period from 2010 to 2018. The data were retrieved from the PIC database (http://pic.nbscn.org).
Results:
A multiple linear regression model was used to assess associations between phosphate and 30-day PICU mortality, finding a significant positive relationship (OR 1.27, 95% CI 1.08 to 1.49). Generalised additive models were also developed, showing a non-linear association between serum phosphate and 30-day PICU mortality. In the two-phase linear regression analysis, the critical point for serum phosphate concentration was identified as 1.2 mmol/L. To the left of this point, serum phosphate levels were inversely correlated (OR 0.2, 95% CI 0.10 to 0.41), whereas to the right, a positive relationship was observed (OR 1.99, 95% CI 1.66 to 2.39).
Conclusions:
The findings demonstrated a relationship between serum phosphate levels and 30-day PICU mortality. The relationship was represented by a U-shaped curve. Hypophosphataemia and hyperphosphataemia increased the risk of 30-day PICU death.
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