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| Predictive value of dynamic serum phosphorus levels in the prognosis of entilator-associated pneumonia |
| Guo Ren-nan, Wang Lu, Xiao Dong |
| Intensive Care Unit, People′s Hospital of Xin jiang Uygur Autonomous Region, Urumqi 830000, China |
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Abstract Objective To explore the predictive value of dynamic serum phosphorus levels in the evaluation of prognosis in patients with ventilator-associated pneumonia (VAP). Methods A retrospective study was conducted. The VAP patients admitted to intensive care unit (ICU) of the People′s Hospital of Xinjiang Uygur Autonomous Region from October 2016 to October 2017 were enrolled, who were ≥ 65 years old. These patients were divided into survival group and death group according to 28-day outcome. The general information, the acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score within 24 hours of ICU admission, the serum phosphorus at 1, 3, 5, 7 days after admission were collected. Receiver operating characteristic curve (ROC) was plotted according to the dynamic serum phosphorus levels for evaluating the predictive value of 28-day prognosis. Results A total of 63 patients with VAP were enrolled, APACHE Ⅱ score in the death group was significantly higher than that in the survival group. Invasive mechanical ventilation time in the death group was significantly higher than that in the survival group. In the survival group, the serum phosphorus level decreased at the early stage, but increased after five days. After the survival group was selected, the levels of serum phosphorus on 1 d, 3 d, 5 d and 7 d were respectively (mmol/L: 1.05±0.22, 0.90±0.16, 0.94±0.25, 1.02±0.25). The serum phosphorus level in the death group showed an overall downward trend, After the death group was selected, the levels of serum phosphorus on 1 d, 3 d, 5 d and 7 d were respectively (mmol/L: 0.98±0.23, 0.83±0.10, 0.80±0.14, 0.81± 0.25 ) . There was no statistically significant difference between the two groups on 1 d and 3 d ( P > 0.05). The serum phosphorus levels of the patients in the death group were lower than those in the survival group at both 5 d and 7 d with statistical significance (all P < 0.05). ROC curve analysis showed serum phosphorus level on the 7th day and 5th day could significantly predict 28-day mortality in patients with VAP, and the areas under ROC curve (AUC) of them were 0.822 and 0.710 respectively (both P < 0.01 ). However, there was no significant predictive value for 1 d and 3 d blood phosphorus levels, with an AUC of 0.590 and 0.674, respectively (both P>0.01). Conclusion The continuous decline of serum phosphorus indicates poor prognosis, and the serum phosphorus level on the 7th day is one of the most important indicators to evaluate the prognosis of patients with VAP.
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Corresponding Authors:
Xiao Dong, E-mail: xiaol972dong@163.com
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