Dynamic observation of the influence of serum phosphorus on the survival of sepsis patients

Abstract:

Objective：To investigate the value of dynamic changes of serum phosphorus concentration in predicting the survival of pa－tients with sepsis. Methods：A retrospective analysis was performed for the clinical data of 92 patients with sepsis who were treated in our hospital from January to December，2017. According to the 28-day survival，the patients were divided into survival group with 63 patients and death group with 29 patients，and the mortality rate was 31.52%. The two groups were compared in terms of clinical da－ta，Acute Physiology and Chronic Health Evaluation Ⅱ（APACHEⅡ） score，and serum phosphorus levels on days 1，3，5，and 7 after admission to the intensive care unit（ICU），and the receiver operating characteristic（ROC） curve was used to evaluate the value of serum phosphorus at different time points and APACHEⅡ score in predicting the survival of patients with sepsis. Results：There were no significant differences in the proportion of patients undergoing invasive mechanical ventilation，the distribution of infection sites，and the duration of ICU stay between the two groups（P>0.05），and the survival group had significantly lower rate of use of vasoactive drugs and APACHE Ⅱ score than the death group（P<0.05）. There was no significant difference in serum phosphorus between the two groups on day 1 after admission to the ICU（P >0.05）；the survival group had a gradual increase in serum phosphorus，while the death group had a gradual reduction；on days 3，5，and 7 after admission to the ICU，the survival group had a significantly higher serum phosphorus level than the death group（P<0.05）. Serum phosphorus level on day 7 after admission to the ICU and APACHEⅡ score had an area under the ROC curve of 0.952（95% confidence interval[CI]：0.912-0.996） and 0.830（95% CI：0.742-0.915），respectively，and thus had a high predictive value. At the cut-off value of 1.02 mmol/L，serum phosphorus level on day 7 after admission to the ICU had a sensitivity of 92.31%，a specificity of 82.61%，a positive likelihood ratio of 5.31，and a negative likelihood ratio of 0.09 in predicting the survival of patients with sepsis. Conclu－sion：The survival group has a gradual increase in serum phosphorus，while the death group has a gradual reduction. Serum phospho－rus level on day 7 after admission to the ICU has the highest sensitivity and specificity in predicting the survival of patients with sep－sis and thus has the highest predictive value.