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Hypophosphatemia: Unraveling a lethal connection with icu mortality in critically ill COVID-19 patients: a
Şahin Temel1, Pervin Hanci2, Akbudak Ismail Hakkı3
1Erciyes University, School of Medicine, Department of Internal Medicine, Division of Intensive Care Medicine, Kayseri, Turkey.
Insights
Hypophosphatemia, a common condition in critically ill COVID-19 patients, is linked to worse outcomes. Monitoring serum phosphorus levels is crucial for improving care and reducing mortality in these patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Nephrology/Urology
Background:
- Hypophosphatemia is associated with adverse outcomes in various patient groups.
- Limited data exists on hypophosphatemia prevalence and impact in critically ill COVID-19 patients.
Purpose of the Study:
- To determine the frequency of hypophosphatemia in critically ill COVID-19 patients.
- To investigate the correlation between serum phosphorus levels and clinical outcomes.
Main Methods:
- Retrospective observational study of 205 RT-PCR confirmed COVID-19 patients.
- Included patients with respiratory failure requiring ICU admission >24 hours.
- Analyzed clinical parameters, comorbidities, respiratory support, and serum phosphorus levels.
Main Results:
- 25% of patients had hypophosphatemia within the first three ICU days (median phosphorus: 1.02 mmol/L).
- Hypophosphatemia was associated with significantly longer ICU stays (p=0.046).
- Day 3 phosphorus levels independently predicted ICU mortality (HR=1.48, p=0.006).
Conclusions:
- Hypophosphatemia affects a significant portion of critically ill COVID-19 patients.
- This condition is linked to increased ICU mortality and prolonged ICU stays.
- Routine monitoring of serum phosphorus is recommended for critically ill COVID-19 patients.
Background:
Despite a lack of sufficient knowledge about the prevalence and impact of hypophosphatemia in critically ill COVID-19 patients, organ dysfunction, adverse clinical outcomes, and increased mortality have been consistently associated with hypophosphatemia across diverse patient populations. This retrospective, observational study aimed to investigate hypophosphatemia (HypoP) frequency and establish the correlation between variations in serum phosphorus levels and outcomes in critically ill patients with SARS-CoV-2.
Methods:
The research comprised 205 patients diagnosed with COVID-19 confirmed via RT-PCR. The study included COVID-19 patients who experienced respiratory failure and were in intensive care for more than 24 hours, and their phosphorus values were accurately documented. Clinical para meters, comorbidities, respiratory support requirements, and laboratory findings were analysed.
Results:
The study participants had a median age of 64 (IQR: 54-75 years), with hypertension being the most pre - valent chronic disease (46%). During the first three days of intensive care, 33% of the participants received conventional oxygen support, whereas 54% required intubation and mechanical ventilation (MV). During this period, hypophosphatemia was noted in 25% of patients, with an ICU admission median serum phosphorus level of 1.02 (0.87-1.25) mmol/L. The median duration of stay in the intensive care unit (ICU) was 7 days, significantly extended in patients with hypophosphatemia (p=0.046). Phosphorus levels on the third day of ICU stay were an independent predictor of ICU mortality. (COX, HR=1.48, 95% CI=1.11-1.98, p=0.006).
Conclusions:
During the first three days of ICU admission, 25% of SARS-CoV-2 critically ill adult patients presented with hypophosphatemia. This condition was found to increase ICU mortality rates and prolong ICU stays. Therefore, it is crucial to monitor serum phosphorus levels in the care of critically ill COVID-19 patients.
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