Prevalence of hypophosphatemia in the ICU - Results of an international one-day point prevalence survey
M M Berger, O Appelberg, A Reintam-Blaser, C Ichai, O Joannes-Boyau, M Casaer, S J Schaller, J Gunst, J Starkopf, ESICM-MEN section, Arroyo Abel, Alberts Erna, M Berger Mette, Besch Guillaume, Besançon Bodolea Costel, Casaer Michael, Cheng Meisy Pérez, Constantin Jean-Michel, Deepak Swarna, M E de Man Angelique, Duska Frantisek, Fodor Patricia, Fuest Kristina, Fumeaux Thierry, Grand Hubert, K Gundogan, Gunst Jan, Gurjar Mohan, Heyer Laurent, Huq Shihan, Ichai Carole, Islam Motiul, Jaber Samir, Jain Nikilesh, Jamme Matthieu, Jammer Ib, Joannes-Boyau Olivier, Jung Veronika, Karu Inga, Keryakos Hesham Kamal Habeeb, Kleger Gian-Reto, Krol Tim, Kuhn Karl Friedrich, Laube Marcus, Launey Yoann, Malbrain Manu, Manrique Ezequiel, Marrel Julien, Martinez-Alejos Roberto, Nicolas Mongardon, Morris Andrew Conway, Pahuja Madhu, Pereira Fernando, Pérez Gema, Perez Marie-Helene, Pfortmuller Carmen, Reintam Blaser Annika, Rosenfeld Ricardo, Samat Noryani, J Schaller Stefan, Simpson Shannon, Straka Kelly, Szakmany Tamas, Tamme Kadri, Van Zanten Arthur, Viana Marina Verçoza, M M Berger, O Appelberg, A Reintam-Blaser, C Ichai, O Joannes-Boyau, M Casaer, S J Schaller, J Gunst, J Starkopf, ESICM-MEN section, Arroyo Abel, Alberts Erna, M Berger Mette, Besch Guillaume, Besançon Bodolea Costel, Casaer Michael, Cheng Meisy Pérez, Constantin Jean-Michel, Deepak Swarna, M E de Man Angelique, Duska Frantisek, Fodor Patricia, Fuest Kristina, Fumeaux Thierry, Grand Hubert, K Gundogan, Gunst Jan, Gurjar Mohan, Heyer Laurent, Huq Shihan, Ichai Carole, Islam Motiul, Jaber Samir, Jain Nikilesh, Jamme Matthieu, Jammer Ib, Joannes-Boyau Olivier, Jung Veronika, Karu Inga, Keryakos Hesham Kamal Habeeb, Kleger Gian-Reto, Krol Tim, Kuhn Karl Friedrich, Laube Marcus, Launey Yoann, Malbrain Manu, Manrique Ezequiel, Marrel Julien, Martinez-Alejos Roberto, Nicolas Mongardon, Morris Andrew Conway, Pahuja Madhu, Pereira Fernando, Pérez Gema, Perez Marie-Helene, Pfortmuller Carmen, Reintam Blaser Annika, Rosenfeld Ricardo, Samat Noryani, J Schaller Stefan, Simpson Shannon, Straka Kelly, Szakmany Tamas, Tamme Kadri, Van Zanten Arthur, Viana Marina Verçoza
Abstract
Background & aims: Hypophosphatemia (HypoP) is associated with organ dysfunction and mortality. Despite its potential severe consequences, HypoP remains poorly characterized in terms of real prevalence and timing of onset. The primary objective was to determine the prevalence of HypoP defined as blood phosphate <0.8 and < 0.65 mmol/l on one particular day at international level.
Methods: One-day point prevalence survey conducted by the Section of Metabolism, Endocrinology and Nutrition (MEN) of the European Society of Intensive Care Medicine (ESICM) during week 11-2020.
Results: In total, 56 adult and 4 paediatric ICUs, from 22 countries participated: 41 ICUs were mixed medico surgical, the 19 others being cardiac, medical or surgical. Phosphate measurements were performed daily in 21 ICUs, and 1-3 times per week in 39 ICUs. On D-Day 909 patients (883 adults) were present and 668/883 (75.7%) had serum/plasma phosphate determined, revealing a HypoP in 103 (15.4%) patients aged 62 [18 to 85] years. Of those, 49 patients presented phosphate <0.65 mmol/l: cases of hypophosphatemia were detected at any time of patient's ICU stay. No HypoP was observed in children. A treatment protocol existed only in 41.1% of adult ICUs, independently of ICU type, or size. Only 41/98 of the HypoP patients (29/41 of patients with phosphate <0.65 mmol/l) were receiving phosphate.
Conclusion: HypoP is present at least in 15.4% of ICU patients, and may occur at any time during the ICU stay. The absence of phosphate repletion protocols in 60% of participating ICUs is an unexpected finding, and confirms the necessity for the development of ICU phosphate protocols and guidelines.
Clinicaltrials identifier: NCT04201899.
Keywords: Critically ill; Electrolyte; Monitoring; Nutrition; Repletion; Standard operating procedure.
Conflict of interest statement
Conflict of interest None of the authors has any conflict to declare related to the present study.
Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Source: PubMed