Research Article
BibTex RIS Cite

COVID-19’lu Hastalarda Hipofosfateminin Morbidite ve Mortalitesi ile İlişkisi

Year 2023, Volume: 7 Issue: 2, 137 - 144, 29.10.2023
https://doi.org/10.30565/medalanya.1296968

Abstract

Amaç: Kritik hastalıklarda hipofosfatemi gibi elektrolit bozukluklarının mortalite ile ilişkisi gösterilmiştir. Biz de çalışmamızda COVID-19’lu hastalarda bir elektrolit bozukluğu olan hipofosfateminin mortalite ile ilişkisini incelemeyi amaçladık.

Gereç ve Yöntemler: Bu retrospektif kesitsel çalışma, hastanemizde COVID-19 tanısı alıp, yatarak tedavi gören hastaları içermektedir. Hastalar, serum fosfor düzeylerine göre iki gruba ayrılmıştır: serum fosfor düzeyi 2.5 mg/dl'nin altında olanlar (hipofosfatemi) ve bu seviyenin üzerinde olanlar (hipofosfatemi olmayanlar). İki grup arasındaki karşılaştırmalar, çeşitli istatistiksel yöntemler kullanılarak yapılmış ve sonuçlar bu veriler ışığında değerlendirilmiştir.

Bulgular: Hipofosfatemi grubuyla karşılaştırıldığında, hipofosfatemi olmayan grupta DM (p<0,001) ve KBY (p=0,015) tanıları istatistiksel olarak anlamlı yüksekti. Fosfor grupları ile mortalite ve yatış süresi arasında da istatistiksel olarak anlamlı farklılık saptandı (p<0.001). Ayrıca yaş ve yatış süreleri sağ olanlara kıyasla exitus olanlarda istatistiksel olarak anlamlı yüksek bulundu (p<0.001; p=0.002).

Sonuç: Hipofosfatemi yapılan birçok çalışmada ve bizim çalışmamızda da olduğu gibi COVID-19’lu hastalarda mortalite ile ilişkisi gösterilmiştir ve şiddetli hastalığı öngörmede bir biyobelirteç olabilir.

Supporting Institution

Yok

Project Number

Yok

Thanks

Yok

References

  • 1. Wang R, He M, Kang Y. Hypophosphatemia at admission is associated with increased mortality in COVID-19 patients. Int J Gen Med. 2021;14:5313-22. DOI: 10.2147/IJGM.S319717
  • 2. Pourfridoni M, Abbasnia SM, Shafaei F, Razaviyan J, Heidari-Soureshjani R. Fluid and electrolyte disturbances in COVID-19 and their complications. BioMed Res Int. 2021; 2021:6667047. DOI: 10.1155/2021/6667047.
  • 3. Al Harbi SA, Al-Dorzi HM, Al Meshari AM, Tamim H, Abdukahil SAI, Sadat M, et al. Association between phosphate disturbances and mortality among critically ill patients with sepsis or septic shock. BMC Pharmacol Toxicol. 2021;22(1):30 doi: 10.1186/s40360-021-00487-w.
  • 4. Alsumrain MH, Jawad SA, Imran NB, Riar S, DeBari VA, Adelman M. Association of hypophosphatemia with failure-to-wean from mechanical ventilation. Ann Clin Lab Sci. 2010;40(2):144-8. PMID: 20421625.
  • 5. Aroca-Martínez G, Avendaño-Echavez L, Garcia C, Ripoll D, Dianda D, Cadena-Bonfanti A, Musso CG. Renal tubular dysfunction in COVID-19 patients. Ir J Med Sci. 2023;192(2):923-927. doi: 10.1007/s11845-022-02993-0. 
  • 6. Bastin MLT, Adams PM, Nerusu S, Morris PE, Mayer KP, Neyra JA. Association of phosphate containing solutions with incident hypophosphatemia in critically ill patients requiring continuous renal replacement therapy. Blood Purif. 2022;51(2):122-9. doi: 10.1159/000514418 .
  • 7. Biber J, Hernando N, Forster I. Phosphate transporters and their function. Annu Rev Physiol. 2013;75:535-50. doi: 10.1146/annurev-physiol-030212-183748.
  • 8. Blaser AR, Gunst J, Ichai C, Casaer MP, Benstoem C, Besch G, et al. Hypophosphatemia in critically ill adults and children–a systematic review. Clin Nutr. 2021;40(4):1744-54. doi: 10.1016/j.clnu.2020.09.045.
  • 9. De Carvalho H, Richard MC, Chouihed T, Goffinet N, Le Bastard Q, Freund Y, et al. Electrolyte imbalance in COVID-19 patients admitted to the Emergency Department: a case–control study. Intern Emerg Med. 2021;16(7):1945-50. doi: 10.1007/s11739-021-02632-z.
  • 10. Fakhrolmobasheri M, Vakhshoori M, Heidarpour M, Najimi A, Mozafari AM, Rezvanian H. Hypophosphatemia in Coronavirus Disease 2019 (COVID-19), Complications, and Considerations: A Systematic Review. BioMed Res Int. 2022;2022:1468786. doi: 10.1155/2022/1468786.
  • 11. Ferreira da Cunha D, Modesto dos Santos V, Pontes Monterio J, Freire de Carvalho da Cunha S. Hypophosphatemia in Acute-Phase Response Syndrome Patients: Preliminary Data. Miner Electrolyte Metab. 1998;24(5):337-40. doi: 10.1159/000057393.
  • 12. Fidecicchi T, Fruzzetti F, Lete Lasa LI, Calaf J. COVID-19, gender and estroprogestins, what do we know? Eur J Contracept Reprod Health Care. 2022;27(1):67-74. doi: 10.1080/13625187.2021.2000959.
  • 13. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. doi: 10.1056/NEJMoa2002032.
  • 14. Korkusuz R, Karandere F, Senoglu S, Kocoglu H, Yasar K. The prognostic role of D-dimer in hospitalized COVID-19 patients. Bratisl Lek Listy. 2021;122(11):811-5. doi: 10.4149/BLL_2021_129.
  • 15. Malinowska J, Małecka-Giełdowska M, Bańkowska D, Borecka K, Ciepiela O. Hypermagnesemia and hyperphosphatemia are highly prevalent in patients with COVID-19 and increase the risk of death. Int J Infect Dis. 2022;122:543-9. doi: 10.1016/j.ijid.2022.06.057.
  • 16. Nahkuri S, Becker T, Schueller V, Massberg S, Bauer-Mehren A. Prior fluid and electrolyte imbalance is associated with COVID-19 mortality. Commun Med (Lond). 2021;1:51. doi: 10.1038/s43856-021-00051-x.
  • 17. Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarcadores asociados con la progresión de la enfermedad COVID-19. Crit Rev Clin Lab Sci. 2020;57(6):389-99. doi: 10.1080/10408363.2020.1770685.
  • 18. Pourhassan M, Müller MJ, Volkert D, Wirth R. Hypophosphatemia as a sign of malnutrition in older hospitalized patients. Eur J Clin Nutr. 2019;73(4):634-6. doi: 10.1038/s41430-018-0251-6.
  • 19. Reber E, Friedli N, Vasiloglou MF, Schuetz P, Stanga Z. Management of Refeeding Syndrome in Medical Inpatients. J Clin Med. 2019;8(12):2202. doi:10.3390/jcm8122202.
  • 20. 20. Shor R, Halabe A, Rishver S, Tilis Y, Matas Z, Fux A, Boaz M, Weinstein J. Severe hypophosphatemia in sepsis as a mortality predictor. Ann Clin Lab Sci. 2006;36(1):67-72. PMID: 16501239.
  • 21. Sjöström A, Rysz S, Sjöström H, Höybye C. Electrolyte and acid-base imbalance in severe COVID-19. Endocr Connect. 2021;10(7):805-14. doi: 10.1530/EC-21-0265.
  • 22. van der Vaart A, Waanders F, van Beek AP, Vriesendorp TM, Wolffenbuttel B, van Dijk PR. Incidence and determinants of hypophosphatemia in diabetic ketoacidosis: an observational study. BMJ Open Diabetes Res Care. 2021;9(1):e002018. doi: 10.1136/bmjdrc-2020-002018.
  • 23. Lima-Martínez MM, Carrera Boada C, Madera-Silva MD, Marín W, Contreras M. COVID-19 and diabetes: A bidirectional relationship. Clin Investig Arterioscler. 2021;33(3):151-7. doi: 10.1016/j.arteri.2020.10.001.

Association of Hypophosphatemia with Morbidity and Mortality in Patients with COVID-19

Year 2023, Volume: 7 Issue: 2, 137 - 144, 29.10.2023
https://doi.org/10.30565/medalanya.1296968

Abstract

Aim: In critical cases, electrolyte disturbances such as hypophosphatemia have been shown to be associated with mortality and in our study, we aimed to examine the relationship between hypophosphatemia, a symptom disorder with COVID-19, and death.

Material and Methods: This study is a retrospective, cross-sectional investigation that encompasses patients diagnosed with COVID-19 and subsequently admitted for treatment at our hospital. Based on their serum phosphate levels, the patients were bifurcated into two distinct categories: those with serum phosphate levels below 2.5 mg/dl, classified as hypophosphatemic, and those with levels above this benchmark, categorized as non-hypophosphatemic. The comparisons drawn between these two cohorts were facilitated using a range of statistical methodologies, and the resulting findings were subsequently analyzed and interpreted within this framework.

Results: Compared to the hypophosphatemia group, the diagnoses of DM (p<0.001) and CKD (p=0.015) were statistically significantly higher in the group without hypophosphatemia. A statistically significant difference was found between phosphorus groups and mortality and length of stay (p<0.001). In addition, age and length of hospitalization were found to be statistically significantly higher in those who died compared to those who were alive (p<0.001; p=0.002).

Conclusions: Hypophosphatemia has been shown to be associated with mortality in patients with COVID-19, as in many studies and in our study, and it may be a biomarker in predicting severe disease.

Project Number

Yok

References

  • 1. Wang R, He M, Kang Y. Hypophosphatemia at admission is associated with increased mortality in COVID-19 patients. Int J Gen Med. 2021;14:5313-22. DOI: 10.2147/IJGM.S319717
  • 2. Pourfridoni M, Abbasnia SM, Shafaei F, Razaviyan J, Heidari-Soureshjani R. Fluid and electrolyte disturbances in COVID-19 and their complications. BioMed Res Int. 2021; 2021:6667047. DOI: 10.1155/2021/6667047.
  • 3. Al Harbi SA, Al-Dorzi HM, Al Meshari AM, Tamim H, Abdukahil SAI, Sadat M, et al. Association between phosphate disturbances and mortality among critically ill patients with sepsis or septic shock. BMC Pharmacol Toxicol. 2021;22(1):30 doi: 10.1186/s40360-021-00487-w.
  • 4. Alsumrain MH, Jawad SA, Imran NB, Riar S, DeBari VA, Adelman M. Association of hypophosphatemia with failure-to-wean from mechanical ventilation. Ann Clin Lab Sci. 2010;40(2):144-8. PMID: 20421625.
  • 5. Aroca-Martínez G, Avendaño-Echavez L, Garcia C, Ripoll D, Dianda D, Cadena-Bonfanti A, Musso CG. Renal tubular dysfunction in COVID-19 patients. Ir J Med Sci. 2023;192(2):923-927. doi: 10.1007/s11845-022-02993-0. 
  • 6. Bastin MLT, Adams PM, Nerusu S, Morris PE, Mayer KP, Neyra JA. Association of phosphate containing solutions with incident hypophosphatemia in critically ill patients requiring continuous renal replacement therapy. Blood Purif. 2022;51(2):122-9. doi: 10.1159/000514418 .
  • 7. Biber J, Hernando N, Forster I. Phosphate transporters and their function. Annu Rev Physiol. 2013;75:535-50. doi: 10.1146/annurev-physiol-030212-183748.
  • 8. Blaser AR, Gunst J, Ichai C, Casaer MP, Benstoem C, Besch G, et al. Hypophosphatemia in critically ill adults and children–a systematic review. Clin Nutr. 2021;40(4):1744-54. doi: 10.1016/j.clnu.2020.09.045.
  • 9. De Carvalho H, Richard MC, Chouihed T, Goffinet N, Le Bastard Q, Freund Y, et al. Electrolyte imbalance in COVID-19 patients admitted to the Emergency Department: a case–control study. Intern Emerg Med. 2021;16(7):1945-50. doi: 10.1007/s11739-021-02632-z.
  • 10. Fakhrolmobasheri M, Vakhshoori M, Heidarpour M, Najimi A, Mozafari AM, Rezvanian H. Hypophosphatemia in Coronavirus Disease 2019 (COVID-19), Complications, and Considerations: A Systematic Review. BioMed Res Int. 2022;2022:1468786. doi: 10.1155/2022/1468786.
  • 11. Ferreira da Cunha D, Modesto dos Santos V, Pontes Monterio J, Freire de Carvalho da Cunha S. Hypophosphatemia in Acute-Phase Response Syndrome Patients: Preliminary Data. Miner Electrolyte Metab. 1998;24(5):337-40. doi: 10.1159/000057393.
  • 12. Fidecicchi T, Fruzzetti F, Lete Lasa LI, Calaf J. COVID-19, gender and estroprogestins, what do we know? Eur J Contracept Reprod Health Care. 2022;27(1):67-74. doi: 10.1080/13625187.2021.2000959.
  • 13. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. doi: 10.1056/NEJMoa2002032.
  • 14. Korkusuz R, Karandere F, Senoglu S, Kocoglu H, Yasar K. The prognostic role of D-dimer in hospitalized COVID-19 patients. Bratisl Lek Listy. 2021;122(11):811-5. doi: 10.4149/BLL_2021_129.
  • 15. Malinowska J, Małecka-Giełdowska M, Bańkowska D, Borecka K, Ciepiela O. Hypermagnesemia and hyperphosphatemia are highly prevalent in patients with COVID-19 and increase the risk of death. Int J Infect Dis. 2022;122:543-9. doi: 10.1016/j.ijid.2022.06.057.
  • 16. Nahkuri S, Becker T, Schueller V, Massberg S, Bauer-Mehren A. Prior fluid and electrolyte imbalance is associated with COVID-19 mortality. Commun Med (Lond). 2021;1:51. doi: 10.1038/s43856-021-00051-x.
  • 17. Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarcadores asociados con la progresión de la enfermedad COVID-19. Crit Rev Clin Lab Sci. 2020;57(6):389-99. doi: 10.1080/10408363.2020.1770685.
  • 18. Pourhassan M, Müller MJ, Volkert D, Wirth R. Hypophosphatemia as a sign of malnutrition in older hospitalized patients. Eur J Clin Nutr. 2019;73(4):634-6. doi: 10.1038/s41430-018-0251-6.
  • 19. Reber E, Friedli N, Vasiloglou MF, Schuetz P, Stanga Z. Management of Refeeding Syndrome in Medical Inpatients. J Clin Med. 2019;8(12):2202. doi:10.3390/jcm8122202.
  • 20. 20. Shor R, Halabe A, Rishver S, Tilis Y, Matas Z, Fux A, Boaz M, Weinstein J. Severe hypophosphatemia in sepsis as a mortality predictor. Ann Clin Lab Sci. 2006;36(1):67-72. PMID: 16501239.
  • 21. Sjöström A, Rysz S, Sjöström H, Höybye C. Electrolyte and acid-base imbalance in severe COVID-19. Endocr Connect. 2021;10(7):805-14. doi: 10.1530/EC-21-0265.
  • 22. van der Vaart A, Waanders F, van Beek AP, Vriesendorp TM, Wolffenbuttel B, van Dijk PR. Incidence and determinants of hypophosphatemia in diabetic ketoacidosis: an observational study. BMJ Open Diabetes Res Care. 2021;9(1):e002018. doi: 10.1136/bmjdrc-2020-002018.
  • 23. Lima-Martínez MM, Carrera Boada C, Madera-Silva MD, Marín W, Contreras M. COVID-19 and diabetes: A bidirectional relationship. Clin Investig Arterioscler. 2021;33(3):151-7. doi: 10.1016/j.arteri.2020.10.001.
There are 23 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section Research Article
Authors

Faruk Karandere 0000-0002-7423-0170

Deniz Yılmaz 0000-0001-9870-5305

Felemez Arslan 0000-0001-8318-1860

Ezgi Şahin 0000-0001-6162-8983

Sema Koyuncu 0009-0008-3092-4868

Project Number Yok
Early Pub Date October 20, 2023
Publication Date October 29, 2023
Submission Date May 14, 2023
Acceptance Date July 12, 2023
Published in Issue Year 2023 Volume: 7 Issue: 2

Cite

Vancouver Karandere F, Yılmaz D, Arslan F, Şahin E, Koyuncu S. Association of Hypophosphatemia with Morbidity and Mortality in Patients with COVID-19. Acta Med. Alanya. 2023;7(2):137-44.

9705

This Journal is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.