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Hospital-acquired serum phosphate derangements and their associated in-hospital mortality
  1. Charat Thongprayoon1,
  2. Wisit Cheungpasitporn1,2,
  3. Api Chewcharat1,
  4. Tananchai Petnak3,
  5. Michael A Mao4,
  6. Narat Srivali5,
  7. Tarun Bathini6,
  8. Saraschandra Vallabhajosyula7,
  9. Fawad Qureshi1,
  10. Kianoush Kashani1,3
  1. 1 Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
  3. 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  4. 4 Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
  5. 5 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Saint Agnes Hospital, Baltimore, Maryland, USA
  6. 6 Department of Internal Medicine, University of Arizona Medical Center, Tucson, Arizona, USA
  7. 7 Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Charat Thongprayoon, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA; charat.thongprayoon{at}gmail.com

Abstract

Background We aimed to report the incidence of hospital-acquired hypophosphataemia and hyperphosphataemia along with their associated in-hospital mortality.

Methods We included 15 869 adult patients hospitalised at a tertiary medical referral centre from January 2009 to December 2013, who had normal serum phosphate levels at admission and at least two serum phosphate measurements during their hospitalisation. The normal range of serum phosphate was defined as 2.5–4.2 mg/dL. In-hospital serum phosphate levels were categorised based on the occurrence of hospital-acquired hypophosphataemia and hyperphosphataemia. We analysed the association of hospital-acquired hypophosphataemia and hyperphosphataemia with in-hospital mortality using multivariable logistic regression.

Results Fifty-three per cent (n=8464) of the patients developed new serum phosphate derangements during their hospitalisation. The incidence of hospital-acquired hypophosphataemia and hyperphosphataemia was 35% and 27%, respectively. Hospital-acquired hypophosphataemia and hyperphosphataemia were associated with odds ratio (OR) of 1.56 and 2.60 for in-hospital mortality, respectively (p value<0.001 for both). Compared with patients with persistently normal in-hospital phosphate levels, patients with hospital-acquired hypophosphataemia only (OR 1.64), hospital-acquired hyperphosphataemia only (OR 2.74) and both hospital-acquired hypophosphataemia and hyperphosphataemia (ie, phosphate fluctuations; OR 4.00) were significantly associated with increased in-hospital mortality (all p values <0.001).

Conclusion Hospital-acquired serum phosphate derangements affect approximately half of the hospitalised patients and are associated with increased in-hospital mortality rate.

  • Internal medicine
  • nephrology

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Footnotes

  • Contributors CT, WC and KK conceived and designed the study. CT, WC, AC, TP, FQ, MAM, NS, TB and SV collected data. CT, WC and AC analysed and interpreted data, and drafted the manuscript. TP, FQ, MAM, NS, TB, SV and KBK critically revised the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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