Hiperfosfatemia en el momento del ingreso como predictor de gravedad y mortalidad en la pancreatitis aguda: un...

Although most acute pancreatitis (AP) cases are mild, up to 20% progress to severe disease, leading to substantial morbidity and mortality. Early risk stratification remains challenging because conventional scoring systems require multiple parameters and often depend on 24-48 hours of observation.

To evaluate whether serum phosphate levels measured upon hospital admission can predict disease severity and short-term clinical outcomes in patients with AP.

We retrospectively analyzed 1000 consecutive patients hospitalized for AP between November 2023 and June 2025. Admission phosphate was categorized as hypophosphatemia (< 2.5 mg/dL), normophosphatemia (2.5-4.5 mg/dL), or hyperphosphatemia (> 4.5 mg/dL). Clinical outcomes included severe AP (SAP), pancreatic necrosis, intensive care unit (ICU) admission, and 30-day all-cause mortality. Multivariable logistic regression was performed to evaluate the independent association between phosphate levels and clinical outcomes, with additional models adjusted for creatinine levels and acute kidney injury (AKI).

SAP occurred in 60% of patients with hyperphosphatemia and in 20% of those with normophosphatemia (P < 0.001). Pancreatic necrosis (50% vs 10%) and ICU admission (70% vs 15%) were also significantly more frequent in the hyperphosphatemia group. Thirty-day mortality was 25% in the hyperphosphatemia group and 3% in the normophosphatemia group. Hyperphosphatemia independently predicted 30-day mortality (adjusted OR 5.8; 95%CI: 2.9-11.5; P < 0.001), and this association remained significant after adjustment for creatinine and AKI (adjusted OR 4.7; 95%CI: 2.1-10.3; P < 0.001).

Admission hyperphosphatemia independently predicts severe disease, pancreatic necrosis, ICU admission, and early mortality, highlighting a simple and inexpensive biomarker to support rapid risk stratification in AP.