血清磷酸盐轨迹对脓毒症患者预后的影响

Effect of Serum Phosphate Trajectory on the Prognosis of Patients with Sepsis

摘要: 目的：本研究旨在探讨血清磷酸盐轨迹对脓毒症患者28天和90天全因死亡率的影响。方法：这项回顾性队列研究使用了来自重症监护医学信息市场(MIMIC)-IV数据库的数据，纳入入住ICU的脓毒症患者。应用群组轨迹模型(GBTM)绘制患者入住ICU7天的血清磷酸盐波动轨迹。Kaplan-Meier生存曲线用于比较具有不同血磷轨迹的脓毒症患者的死亡率差异。使用Cox比例风险模型计算风险比(HR)以确定轨迹与预后之间的关联。结果：共纳入25,451例脓毒症患者，确定了4种血磷轨迹，包括：持续正常组、先低后高组、先高后低组、持续高磷组。调整后的COX回归分析，在28天死亡率中，与持续正常组相比，先低后高组HR 1.96 (95%置信区间[CI] 1.82~2.12，P < 0.001)，先高后低组HR 1.41 (95%置信区间[CI] 1.29~1.55，P < 0.001)，持续高磷组HR 2.83 (95%置信区间[CI] 2.53~3.16，P < 0.001)；在90天死亡率中，先低后高组HR 1.77 (95%置信区间[CI] 1.65~1.89，P < 0.001)，先高后低组HR 1.36 (95%置信区间[CI] 1.26~1.47，P < 0.001)，持续高磷组HR 2.45 (95%置信区间[CI] 2.21~2.71，P < 0.001)。结论：血清磷酸盐轨迹与脓毒症患者28天死亡率和90天死亡率独立相关，血磷轨迹与脓毒症患者预后之间的关系值得进一步研究。

Abstract: Objective: The aim of this study was to investigate the effect of serum phosphate trajectory in 28- and 90-day all-cause mortality in patients with sepsis. Methods: This retrospective cohort study used data from the Medical Information Mart for Intensive Care (MIMIC)-IV database and included sepsis patients admitted to the ICU. Group-Based Trajectory Modeling (GBTM) was applied to plot the trajectory of serum phosphate fluctuations in patients admitted to the ICU for 7 days, and Kaplan-Meier survival curves were used to compare the differences in mortality rates among septic patients with different blood phosphorus trajectories. Hazard Ratio (HR) was calculated using Cox proportional risk modeling to determine the association between trajectory and prognosis. Results: A total of 25,451 patients with sepsis were included, and four blood phosphate trajectories were identified, including: a consistently normal group, a low-then-high group, a high-then-low group, and a consistently high-phosphorus group. Adjusted COX regression analyses, in 28-day mortality, HR 1.96 (95% confidence interval [CI] 1.82~2.12, P < 0.001) in the low-first-high group, HR 1.41 (95% confidence interval [CI] 1.29~1.55, P < 0.001) in the high-first-high group, and HR 2.83 (95% confidence interval [CI] 2.53~3.16, P < 0.001); in 90-day mortality, HR 1.77 (95% confidence interval [CI] 1.65~1.89, P < 0.001) in the low-first-high group, HR 1.36 (95% confidence interval [CI] 1.26~1.47, P < 0.001) in the high-first-high group, and HR 2.45 ( 95% confidence interval [CI] 2.21~2.71, P < 0.001). Conclusion: Serum phosphate trajectories are independently associated with 28-day mortality and 90-day mortality in patients with sepsis, and the relationship between blood phosphate trajectories and prognosis in patients with sepsis warrants further investigation.