Hyperphosphatemia-a predictor of poor prognosis among patients with sepsis or septic shock


  • Rakshith A. Department of General Medicine, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India
  • Yogitha C. Department of General Medicine, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India
  • Basanth Kumar S. Department of General Medicine, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India




Hypophosphatemia, Hyperphosphatemia, Mortality, Serum phosphate


Background: Sepsis is a life-threatening organ dysfunction resulting from dysregulated host responses to infection. Serum phosphorus level was closely related to the occurrence and prognosis of kidney disease and cardiovascular disease. It is of vital importance to re-evaluate the association between serum Phosphorus level and mortality in patients with sepsis and different septic subgroups. This study aims to examine the association of serum phosphorous levels with clinical outcomes among patients with sepsis.

Methods: This study included 100 cases and was conducted at KIMS hospital Bangalore. Patients were included in the study as per inclusion criteria. SOFA scoring and APACHE-II scoring was done on first day of admission and serum phosphorus levels were sent. Patients were categorised according to phosphorous levels normal range (2.5-4.5mg/dl).  Patients were followed up till primary and secondary outcome.

Results: Of the 100 patients in this study 53 patients had normophosphatemia, 17 patients had hypophosphatemia, 30 patients had hyperphosphatemia. Comparison of mean APACHE-II scores, mean length of ICU stay (in days), mean length of hospital stay (in days), serum creatinine levels, between 3 groups was statistically significant. 

Conclusions: Hyperphosphatemia on first ICU admission day indicates poor clinical outcome among patients with sepsis or septic shock. Therefore, when patients are on ICU admission and under treatment, clinicians should pay more attention to the change of serum phosphate.


Torio CM, Andrews RM. National inpatient hospital costs: the most expensive conditions by payer. 2011.

Singer M, Deutschman CS, Seymour CW. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10.

Vincent JL, Marshall JC, Namendys-Silva SA, Francois B, Martin-Loeches I, Lipman J, et al. Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Respir Med. 2014;2:380-6.

Cecconi M, Evans L, Levy M, Rhodes A. Sepsis and septic shock. Lancet. 2018;392:75-87.

Opal SM, Wittebole X. Biomarkers of Infection and Sepsis. Crit Care Clin. 2020;36:11-22.

Kalantar-Zadeh K, Kuwae N, Regidor DL, Kovesdy CP, Kilpatrick RD, Shinaberger CS, et al. Survival predictability of time-varying indicators of bone disease in maintenance hemodialysis patients. Kidney Int. 2006;70:771-80.

Cohen J, Kogan A, Sahar G, Lev S, Vidne B, Singer P. Hypophosphatemia following open heart surgery: incidence and consequences. Eur J Cardiothorac Surg. 2004;26:306-10.

Shor R, Halabe A, Rishver S, Tilis Y, Matas Z, Fux A, et al. Severe hypophosphatemia in sepsis as a mortality predictor. Ann Clin Lab Sci. 2006;36:67-72.

Miller CJ, Doepker BA, Springer AN, Exline MC, Phillips G, Murphy CV. Impact of serum phosphate in mechanically ventilated patients with severe sepsis and septic shock. J Intensive Care Med. 2020;35:485-93.

Zheng Liu, Teng Li, Yihan Du, Chenhu Li, Wei Chong. Both hypophosphatemia and hyperphosphatemia are associated with increased mortality in septic patients. Front Nephrol. 2022.

Wang H, Zhang L, Liao W, Huang J, Xu J, Yang J, et al. Hyperphosphatemia rather than hypophosphatemia indicates a poor prognosis in patients with sepsis. Clin Biochem. 2021;91:9-15.

Al Harbi SA, Al-Dorzi HM, Al Meshari AM, Tamim H, Abdukahil SAI, Sadat M, et al. Association between phosphate disturbances and mortality among critically ill patients with sepsis or septic shock. BMC Pharmacol Toxicol. 2021;22(1):30.

Chung PY, Sitrin MD, Te HS. Serum phosphorus levels predict clinical outcome in fulminant hepatic failure. Liver Transpl. 2003;9(3):248-53.

Zazzo JF, Troché G, Ruel P, Maintenant J. High incidence of hypophosphatemia in surgical intensive care patients: Efficacy of phosphorus therapy on myocardial function. Intensive Care Med. 1995;21(10):826-31.

Geerse DA, Bindels AJ, Kuiper MA, Roos AN, Spronk PE, Schultz MJ. Treatment of hypophosphatemia in the intensive care unit: A review. Crit Care. 2010;14(4):R147.

Haider DG, Lindner G, Wolzt M, Ahmad SS, Sauter T, Leichtle AB, et al. Hyperphosphatemia Is an Independent Risk Factor for Mortality in Critically Ill Patients: Results from a Cross-Sectional Study. PloS One. 2015;10(8):e0133426.




How to Cite

A., R., C., Y., & S., B. K. (2023). Hyperphosphatemia-a predictor of poor prognosis among patients with sepsis or septic shock. International Journal of Research in Medical Sciences, 11(4), 1114–1118. https://doi.org/10.18203/2320-6012.ijrms20230679



Original Research Articles