The Plasma Phosphorus and Mortality from Emergency Department to Intensive Care; A Retrospective Analysis
DOI:
https://doi.org/10.5281/zenodo.10020949Keywords:
Emergency Department, Intensive Care Unit, hyperphosphatemia, mortalityAbstract
Aim: Effective management of unstable patients in the emergency department during the golden hours significantly reduces mortality and morbidity. The world population is getting older and emergency room crowding is increasing. The aim of the study was to analyze the demographic characteristics, initial laboratory values and results of the patients through a retrospective analysis of non-traumatic patients who were admitted to the intensive care unit from the emergency department.
Materials and Methods: In the study, 1067 patients were included. Blood glucose, phosphorus, platelet, MPW, PDW values and demographic data were taken during the first examinations upon admission to the emergency department. Diagnoses were divided into six groups: pulmonary, internal diseases, cardiac, neurological, poisonings and infections. Outcomes were analyzed.
Results: The mean age of 1067 patients who met the criteria in the study was 69.16±15.61 years and 51.2% were male. Considering the reasons for hospitalization from the emergency service to the Intensive Care; the most frequent hospitalizations were pulmonary with 31.0% (n=337), neurological with 22.1% (n=240) and cardiac with 20.9%. Cut-off point for blood phosphorus levels ≥ 4.15 mg/dL, sensitivity 47.0% specificity 73.0% area under the ROC curve ± standard error (AUC ± SE) = 0.62 ± in patients hospitalized from the Emergency Department to the Intensive Care Unit and nonsurvivor 0.020 (p < 0.001).
Conclusion: Although the study has limitations, it was assumed that the phosphorus level pathologies of critically ill patients at the time of their first admission to the emergency department would negatively affect mortality. To clarify this issue, a large retrospective observational study is needed to determine whether patients with episodes of hypo-hyperphosphatemia have increased morbidity or mortality compared to patients with normal phosphate values. It can be predicted that phosphorus may be an important parameter in mortality scoring in emergency departments in the future.
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Kemp K, Alakare J, Kätkä M, Lääperi M, Lehtonen L, Castrén M. Accuracy of Emergency Severity Index in older adults. Eur J Emerg Med. 2022;29(3):204-209. doi:10.1097/MEJ.0000000000000900.
Mohr NM, Wessman BT, Bassin B, Elie-Turenne MC, Ellender T, Emlet LL, Ginsberg Z, Gunnerson K, Jones KM, Kram B, Marcolini E, Rudy S. Boarding of Critically Ill Patients in the Emergency Department. Crit Care Med. 2020 Aug;48(8):1180-1187. doi: 10.1097/CCM.0000000000004385. PMID: 32697489; PMCID: PMC7365671
Betro MG, Pain RW. Hypophosphataemia and hyperphosphataemia in a hospital population. Br Med J. 1978;29(1(5975)):273–6. . [PMC free article] [PubMed] [Google Scholar]
Kuo G, Lee CC, Yang SY, Hsiao YC, Chuang SS, Chang SW, Tu KH, Fan PC, Tian YC, Chen YC, Chang CH. Hyperphosphatemia is associated with high mortality in severe burns. PLoS One. 2018 Jan 9;13(1):e0190978. doi: 10.1371/journal.pone.0190978. PMID: 29315336; PMCID: PMC5760089.
Broman M, Wilsson AMJ, Hansson F, Klarin B. Analysis of Hypo- and Hyperphosphatemia in an Intensive Care Unit Cohort. Anesth Analg. 2017;124(6):1897-1905. doi:10.1213/ANE.0000000000002077.
Amanzadeh J, Reilly RF Jr.. Hypophosphatemia: an evidence-based approach to its clinical consequences and management. Nat Clin Pract Nephrol. 2006;2:136–148.
Farah R, Khamisy-Farah R, Arraf Z, Jacobson L, Makhoul N. Hypophosphatemia as a prognostic value in acute exacerbation of COPD. Clin Respir J. 2013;7:407–415.
Farrow EG, White KE. Recent advances in renal phosphate handling. Nature reviews Nephrology. 2010;6(4):207-17.
Kao CC, Chen YC, Huang HH, Hsu TF, Yen DH, Fan JS. Prognostic significance of emergency department modified early warning score trend in critical ill elderly patients. Am J Emerg Med. 2021;44:14-19. doi:10.1016/j.ajem.2021.01.047
Zhang S, Cui YL, Diao MY, Chen DC, Lin ZF. Use of Platelet Indices for Determining Illness Severity and Predicting Prognosis in Critically Ill Patients. Chin Med J (Engl). 2015;128(15):2012-2018. doi:10.4103/0366-6999.161346
Zhang Z, Xu X, Ni H, Deng H. Platelet indices are novel predictors of hospital mortality in intensive care unit patients. J Crit Care. 2014;29:885.e1–6. [PubMed] [Google Scholar]
Sezgi C, Taylan M, Kaya H, Selimoglu Sen H, Abakay O, Demir M, et al. Alterations in platelet count and mean platelet volume as predictors of patient outcome in the respiratory intensive care unit. Clin Respir J. 2014 [Epub ahead of print] [PubMed] [Google Scholar]
Safar P. Critical care medicine---quo vadis?. Crit Care Med. 1974;2(1):1-5. doi:10.1097/00003246-197401000-00001
Shor R, Halabe A, Rishver S, et al. Severe hypophosphatemia in sepsis as a mortality predictor. Ann Clin Lab Sci. 2006;36(1):67-72.
Xu X, Zhang L, Liu W, et al. Analysis Of The Relationship Between Early Serum Phosphate Levels And Short-Term Mortality In Septic Patients: A Retrospective Study Based On MIMIC-IV. Shock. 2023;59(6):838-845. doi:10.1097/SHK.0000000000002119
Jang DH Jo YH Lee JH, et al.. Moderate to severe hyperphosphataemia as an independent prognostic factor for 28-day mortality in adult patients with sepsis. Emerg Med J. 2020;37(6):355–361. [PubMed] [Google Scholar] [Ref list]
Naffaa ME, Mustafa M, Azzam M, Nasser R, Andria N, Azzam ZS, et al. Serum inorganic phosphorus levels predict 30-day mortality in patients with community acquired pneumonia. BMC Infect Dis. 2015;15:332 doi: 10.1186/s12879-015-1094-6 ; [PMC free article] [PubMed] [Google Scholar]
Haider DG, Lindner G, Wolzt M, Ahmad SS, Sauter T, Leichtle AB, et al. Hyperphosphatemia Is an Independent Risk Factor for Mortality in Critically Ill Patients: Results from a Cross-Sectional Study. PLoS One. 2015;10(8):e0133426 doi: 10.1371/journal.pone.0133426 ; [PMC free article] [PubMed] [Google Scholar]
Efe S, Asker İ. İnal V. Karma Yoğun Bakımda Takip Edilen Kritik Hastalarda Platelet İndekslerinin Prognostik Değeri. Yoğun Bakım Derg 2019; 10(1):13-7
Steiropoulos P, Papanas N, Nena E, Xanthoudaki M, Goula T, Froudarakis M, et al. Mean platelet volume and platelet distribution width in patients with chronic obstructive pulmonary disease: The role of comorbidities. Angiology. 2013;64:535–9. [PubMed] [Google Scholar] [Ref list]
Al-Sweedan SA, Alhaj M. The effect of low altitude on blood count parameters. Hematol Oncol Stem Cell Ther. 2012;5:158–61. [PubMed] [Google Scholar] [Ref list]
M Koyuncu, S Koyuncu, S Biberoglu, AR Benli, S Koyuncu, B Atli Hyperglycaemia in the emergency department: stress hyperglycaemia or diabetes mellitus. Biomedical Research 28 (4), 1523-1527
Vedantam D, Poman DS, Motwani L, Asif N, Patel A, Anne KK. Stress-Induced Hyperglycemia: Consequences and Management. Cureus. 2022;14(7):e26714. Published 2022 Jul 10. doi:10.7759/cureus.26714
Mamtani M, Kulkarni H, Bihari S, et al. Degree of hyperglycemia independently associates with hospital mortality and length of stay in critically ill, nondiabetic patients: Results from the ANZICS CORE binational registry. J Crit Care. 2020;55:149-156. doi:10.1016/j.jcrc.2019.11.003
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