title: Incidence and Clinical Outcome of Hypophosphatemia in Pediatric Burn Patients.
abstract: The objective of this study is to investigate the factors associated with serum phosphate concentrations in severely burned children and whether hypophosphatemia is associated with outcome. Seventy-eight children with a total body surface area of 24% (6.0-68.5) were retrospectively analyzed for serum phosphate concentrations during the first 10 days of stay in the intensive care unit (ICU). The method of generalized estimating equations was used to evaluate the effect of the exposure variables for serum phosphate concentrations during the study period. Outcome variables were the probability of ICU discharge at 30 days and time on mechanical ventilation. Potential explanatory variables for clinical outcome were hypophosphatemia (serum phosphate <3.8 mg/dL for children <2 years and <3.5 mg/dL for older children), age, sex, percent total body surface area burn, inhalation injury, and severe sepsis and/or septic shock. Competing-risk analysis was applied to calculate the probability of ICU discharge at 30 days, and death was assumed as the competing event. The rate of hypophosphatemia was 79.5%. Serum phosphate concentrations were associated with C-reactive protein (coefficient: -0.63; 95% confidence interval [CI]: -0.96 to -0.30; P = .001). Hypophosphatemia was independently associated with a 68% decrease in the probability of ICU discharge at 30 days (subhazard ratio: -0.32; 95% CI: 0.20, 0.53; P = .001) and an increase of 2.9 days in mechanical ventilation (coefficient: 2.91; 95% CI: 1.16, 4.66; P = .001). Serum phosphate concentrations in pediatric burn patients are associated with the magnitude of inflammatory response. Hypophosphatemia is associated with decreased probability of ICU discharge and increased time on mechanical ventilation.
authors.affiliation: From the *Department of Pediatrics, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil; and †Discipline of Nutrition and Metabolism, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Heitor Pons
authors.initials: HP
authors.lastname: Leite
authors.forename: Larissa Araújo
authors.initials: LA
authors.lastname: Pinheiro Nogueira
authors.forename: Ariane Helena Calassa
authors.initials: AH
authors.lastname: Teodosio
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D001830:Body Surface Area; D001938:Brazil; D002056:Burns / Q000097:blood* / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D017674:Hypophosphatemia / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015601:Injury Severity Score; D015278:Intensive Care Units, Pediatric; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D015999:Multivariate Analysis; D011379:Prognosis; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome