ICU-Admission Hyperphosphataemia Is Related to Shock and Tissue Damage, Indicating Injury Severity and Mortality in Polytrauma Patients
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
References
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All Patients | Admission Phosphate | Admission Phosphate | p | ||
---|---|---|---|---|---|
≤1.45 mmol/L | >1.45 mmol/L | p | |||
(n = 166) | (n = 110) | (n = 56) | (Bonferroni Corrected) | ||
n (%) or Median (IQR) | n (%) or Median (IQR) | n (%) or Median (IQR) | |||
ICU-admission phosphate [mmol/L] | 1.20 (0.92–1.57) | 1.00 (0.86–1.20) | 1.94 (1.57–2.68) | <0.001 | <0.001 |
Age [yrs] | 47 (31–57) | 47 (33–57) | 46 (28–58) | 0.743 | 1 |
Sex | |||||
Male | 129 (77.7) | 90 (81.8) | 39 (69.6) | 0.113 | 1 |
Female | 37 (22.3) | 20 (18.2) | 17 (30.4) | ||
BMI [kg/m2] | 24.7 (23.1–26.3) | 24.7 (23.4–26.3) | 25.4 (22.5–26.3) | 0.289 | 1 |
Comorbidities | |||||
Any | 61 (36.7) | 41 (37.3) | 20 (35.7) | 0.979 | 1 |
Arterial hypertension | 25 (15.1) | 17 (15.5) | 8 (14.3) | 1.000 | 1 |
Cerebrovascular disease | 5 (3.0) | 5 (4.5) | 0 (0) | 0.254 | 1 |
COPD | 3 (1.8) | 2 (1.8) | 1 (1.8) | 1.000 | 1 |
Coronary artery disease | 11 (6.6) | 8 (7.3) | 3 (5.4) | 0.889 | 1 |
Diabetes mellitus type 2 | 5 (3.0) | 4 (3.6) | 1 (1.8) | 0.858 | 1 |
Heart failure | 7 (4.2) | 4 (3.6) | 3 (5.4) | 0.910 | 1 |
Chronic kidney disease | 0 (0) | 0 (0) | 0 (0) | 1.000 | 1 |
Peripheral artery disease | 0 (0) | 0 (0) | 0 (0) | 1.000 | 1 |
Other | 50 (30.1) | 35 (31.8) | 15 (26.8) | 0.625 | 1 |
Injury severity score | 29 (22–41) | 26 (22–34) | 38 (30–44) | <0.001 | <0.001 |
Abbreviated injury scale | |||||
Head or neck | 2 (0–4) | 2 (0–4) | 2 (0–4) | 0.576 | 1 |
Face | 0 (0–1) | 0 (0–1) | 0 (0–0) | 0.141 | 1 |
Chest | 3 (3–4) | 3 (2–4) | 3 (3–4) | 0.081 | 1 |
Abdomen | 2 (0–3) | 1 (0–2) | 3 (0–4) | <0.001 | 0.002 |
Extremities/pelvic girdle | 2 (0–3) | 2 (0–3) | 2 (0–3) | 0.796 | 1 |
External | 0 (0–1) | 0 (0–1) | 0 (0–1) | 0.447 | 1 |
Body temp. at hospital arrival [°C] | 35.4 (34.8–36.4) | 36.0 (35.3–36.5) | 35.0 (33.4–35.5) | 0.013 | 0.521 |
SAPS 3 (ICU admission) | 50 (38–63) | 44 (35–56) | 63 (52–71) | <0.001 | <0.001 |
SOFA Score (ICU admission) | 10 (7–12) | 9 (6–10) | 12 (10–14) | <0.001 | <0.001 |
Intensive care unit | |||||
Length of stay [d] | 7 (3–14) | 8 (2–14) | 7 (3–12) | 0.828 | 1 |
Mortality | 23 (13.9) | 5 (4.5) | 18 (32.1) | <0.001 | <0.001 |
In-hospital | |||||
Length of stay [d] | 17 (9–34) | 21 (11–34) | 12 (4–27) | 0.001 | 0.043 |
Mortality | 26 (15.7) | 6 (5.5) | 20 (35.7) | <0.001 | <0.001 |
Admission Phosphate | Admission Phosphate | p | Correlation with Admission Phosphate Levels Spearman’s Rho (p) | ||
---|---|---|---|---|---|
≤1.45 mmol/L | >1.45 mmol/L | p | |||
(n = 110) | (n = 56) | (Bonferroni Corrected) | |||
n (%) or Median (IQR) | n (%) or Median (IQR) | ||||
Markers of tissue damage on admission | |||||
ASAT [U/L] | 72 (46–154) | 170 (90–431) | 0.001 | 0.043 | 0.44 (<0.001) |
ALAT [U/L] | 53 (33–121) | 120 (62–319) | 0.001 | 0.043 | 0.39 (<0.001) |
LDH [U/L] | 341 (253–425) | 485 (317–666) | 0.005 | 0.187 | 0.48 (<0.001) |
Myoglobin [µg/L] | 1840 (518–2094) | 3037 (1454–6362) | 0.002 | 0.078 | 0.44 (<0.001) |
Creatinine [mg/dL] | 0.96 (0.86–1.10) | 1.25 (1.08–1.47) | <0.001 | <0.001 | 0.49 (<0.001) |
Markers of shock on admission | |||||
Lactate [mg/dL] | 16 (11–23) | 46 (25–78) | <0.001 | <0.001 | 0.65 (<0.001) |
Glucose [mg/dL] | 138 (116–165) | 176 (137–255) | <0.001 | 0.029 | 0.39 (<0.001) |
Admission day resuscitation # | |||||
Packed red blood cells [mL] | 0 (0–560) | 500 (0–1585) | 0.029 | 1 | |
Fresh frozen plasma [mL] | 0 (0–0) | 0 (0–288) | <0.001 | 0.024 | |
Colloids [mL] | 3002 (2000–4500) | 4002 (2500–5500) | 0.014 | 0.575 | |
Crystalloids [mL] | 2449 (1601–3497) | 2188 (1569–3516) | 0.326 | 1 | |
Norepinephrine [µg/kg/min] * | 0.11 (0.04–0.21) | 0.28 (0.16–0.39) | <0.001 | 0.001 |
Variable | Crude Odds Ratio | Adjusted Odds Ratio | p |
---|---|---|---|
(95% CI) | (95% CI) | ||
Age | 1.03 (1.00–1.05) | 1.03 (1.00–1.07) | 0.048 |
Sex (female vs. male) | 1.70 (0.67–4.30) | 1.35 (0.41–4.53) | 0.622 |
Pre-existing comorbidity | 1.09 (0.46–2.58) | 0.93 (0.30–2.88) | 0.896 |
Injury severity score | 1.07 (1.03–1.10) | 1.03 (1.00–1.07) | 0.089 |
Admission phosphate levels | |||
0.80–1.45 mmol/L | reference | ||
<0.80 mmol/L | 0.89 (0.10–8.11) | 0.95 (0.10–8.99) | 0.966 |
1.46–2.10 mmol/L | 4.96 (1.44–17.03) | 3.96 (1.03–15.16) | 0.045 |
>2.10 mmol/L | 18.42 (5.57–60.87) | 12.81 (3.45–47.48) | <0.001 |
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Rugg, C.; Bachler, M.; Kammerlander, R.; Niederbrunner, D.; Bösch, J.; Schmid, S.; Kreutziger, J.; Ströhle, M. ICU-Admission Hyperphosphataemia Is Related to Shock and Tissue Damage, Indicating Injury Severity and Mortality in Polytrauma Patients. Diagnostics 2021, 11, 1548. https://doi.org/10.3390/diagnostics11091548
Rugg C, Bachler M, Kammerlander R, Niederbrunner D, Bösch J, Schmid S, Kreutziger J, Ströhle M. ICU-Admission Hyperphosphataemia Is Related to Shock and Tissue Damage, Indicating Injury Severity and Mortality in Polytrauma Patients. Diagnostics. 2021; 11(9):1548. https://doi.org/10.3390/diagnostics11091548
Chicago/Turabian StyleRugg, Christopher, Mirjam Bachler, Robert Kammerlander, Daniel Niederbrunner, Johannes Bösch, Stefan Schmid, Janett Kreutziger, and Mathias Ströhle. 2021. "ICU-Admission Hyperphosphataemia Is Related to Shock and Tissue Damage, Indicating Injury Severity and Mortality in Polytrauma Patients" Diagnostics 11, no. 9: 1548. https://doi.org/10.3390/diagnostics11091548