CORRELATION BETWEEN NUTRITION, PHOSPHATE LEVEL

AND LENGTH OF VENTILATION IN CRITICALLY ILL

PATIENTS WHO NEED RENAL REPLACEMENT THERAPY
L. Statlender 1, M. Hellerman 1, G. Fishman 1, I. Kagan 1, I. Bendavid 1, M. Makalde 1, O. Raphaeli 2 and P. Singer 1
1. Intensive Care Unit, Rabin Medical Center, Petah Tikva, Israel
2. Industrial Engineering and Management, Ariel University, Ariel, Israel

INTRODUCTION RESULTS
Pearson correlation coefficients between

Hypophosphatemia (P<2.5mg/dL) is
associated with prolonged ventilation and
may be correlated with increased
mortality.
Acute kidney injury requiring renal
replacement therapy (RRT) is associated
with a 50% morality rate and prolonged
length of ventilation.
We studied the relationship between
nutrition, blood phosphate levels, and
length of ventilation critical care patients
who needed RRT.
METHOD
retrospective analysis of prospectively
collected data of all the patients who were
1374 out of 1376 admissions were
analysed. Hypophosphatemia was found in
503 (36.61%) admissions. RRT was
prescribed in 118 (8.6%) admissions – 51
CRRT and 67 IHD.
Patients who needed RRT were older, and
had higher severity scores than patients
who did not. There were no significant
difference in baseline characteristics
between CRRT and IHD patients except
from higher BMI and SOFA24 in CRRT
patients.
RRT modalities prevalance in patientes
with and without hypophosphatemia
CRRT IHD no RRT
100%
92.45%
50%
Presented at:
RRT need was similar between patients Patients who needed RRT were more %calories administered, minimal phosphate
with and without hypophosphatemia. frequently ventilated (98% CRRT, 73.13% level and length of ventilation (LOV) are
However, CRRT prevalence was IHD, 66.48% without RRT, p<0.03). presented in the table. All are significant
significantly higher in the patients with RRT was associated with prolonged but %calories administered and minimal
hypophosphatemia and IHD rates was ventilation comparing to patients who did phosphate in IHD patients.
significantly lower. not need RRT: 8 days more for CRRT, and IHD CRRT
Hypophosphatemia was much more 6 days more for IHD (p<0.001)
prevalent in CRRT patients than in no RRT minimal P and LOV -0.3 -0.39
Hypophosphatemia was associated with
patients and IHD patients (17.91%, p<0.01) %cal and minimal P 0.04 -0.45
prolonged ventilation in all RRT modalities:
%cal and LOV 0.39 0.57
8 days more in patients without RRT, 6.9
days more in IHD and 12.4 days more in Mortality rate of patients who needed RRT
CRRT
137 (p<0.02) was higher than those who did not (CRRT
52.94%, IHD 29.85%, no RRT 12.66%,
Hypophosphatemia prevalence in each Length of ventilation by minmal phosphate
RRT modality
p<0.002), but difference in mortality rates
level according to RRT modality
hypophosphatemia no hypophosphatemia
of patients with or without
40 hypophosphatemia in RRT patients was
100% CRRT
90.82% 90%
35 IHD not significant.
80% 30 no RRT
IHD CRRT
49.02% Linear (CRRT)

LOV (days)
admitted to a 16-bed general mixed 70% 62.98% 25 Linear (IHD)
25%
60%
% mortality with hypoP 27.27% 68%
medical-surgical adult ICU from two 82.09% 20 Linear (RRT)
13% 50% Linear (no RRT) % mortality without hypoP 40.54% 40%
consecutive years (2019-2020) 15
p<0.002 40% P value 0.528 0.178
Date obtained included: 6% 10
p<0.04 6.31% 30%
50.98% 5
- baseline characteristics 3%
5.17% 20% 37.02%
- severity scores 2.87% 10% 17.91% 0
2.39%
2% 0% 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
- phosphate levels
hypophosphatemia no hypophosphatemia CRRT IHD no RRT minimal phosphate level (mg/dL)
- calories prescribed during admission
(EN and/or PN)
- REE using Faisy-Fagon formula
- RRT modality that was given 6. Cohen J, Kogan A, Sahar G, Lev S, Vidne B, Singer P. Hypophosphatemia following

- continues renal replacement(CRRT) CONCLUSIONS REFERENCES open heart surgery: incidence and consequences. Eur J Cardiothorac Surg.
2004;26(2):306-310. doi:10.1016/j.ejcts.2004.03.004
duration 1. Suzuki S, Egi M, Schneider AG, Bellomo R, Hart GK, Hegarty C. Hypophosphatemia in
7. Zusman O, Theilla M, Cohen J, Kagan I, Bendavid I, Singer P. Resting energy

Liran Statlender
expenditure, calorie and protein consumption in critically ill patients: a retrospective
- number of intermittent hemodialysis Hypophosphatemia is correlated with increased critically ill patients. J Crit Care. 2013;28(4):536.e9-536.e19. doi:10.1016/j.jcrc.2012.10.011 cohort study. Crit Care Lond Engl. 2016;20(1):367. doi:10.1186/s13054-016-1538-4

(IHD)
- Outcome: mortality, length of stay and
length of ventilation
Statistical analysis were performed,
including students t test, chi square test,
Critical care
caloric supply 2. Sin JCK, King L, Ballard E, Llewellyn S, Laupland KB, Tabah A. Hypophosphatemia and
Outcomes in ICU: A Systematic Review and Meta-Analysis. J Intensive Care Med. Published
online August 12, 2020:885066620940274. doi:10.1177/0885066620940274
Hypophosphatemia is associated with increased 3. Berger MM, Appelberg O, Reintam-Blaser A, et al. Prevalence of hypophosphatemia in the CONTACT INFORMATION
length of ventilation in both CRRT and IHD ICU - Results of an international one-day point prevalence survey. Clin Nutr Edinb Scotl.
Published online December 29, 2020. doi:10.1016/j.clnu.2020.12.017 Liran Statlender
patients 4. Shor R, Halabe A, Rishver S, et al. Severe hypophosphatemia in sepsis as a mortality
Intensive Care Unit, Rabin Medical Center

and multivariate logistic regression with
backward elimination
PD-ePoster-006
predictor. Ann Clin Lab Sci. 2006;36(1):67-72.
Hypophosphatemia did not impact mortality in 5. Marik PE, Bedigian MK. Refeeding hypophosphatemia in critically ill patients in an intensive Zeev Jabotinsky St 39, Petah Tikva, 49100
RRT patients care unit. A prospective study. Arch Surg Chic Ill 1960. 1996;131(10):1043-1047. Israel
doi:10.1001/archsurg.1996.01430220037007 Email: liranst1@clalit.org.il
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