DOI: https://doi.org/10.22263/2312-4156.2025.6.47
S.A. Tachyla1,2, A.V. Marochkov1,2, D.A. Yakimov1,2, N.N. Hapeyeva1
Efficacy evaluation of hypophosphatemia correction in patients with abdominal sepsis
1Mogilev Regional Clinical Hospital, Mogilev, Republic of Belarus
2Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
Vestnik VGMU. 2025;24(6):47-55.
Abstract.
Objectives. To determine the effectiveness of hypophosphatemia correction in patients with abdominal sepsis and its impact on treatment outcomes.
Material and methods. A non-randomized, observational study was conducted in patients with abdominal sepsis. 67 patients were included in the study.
The study identified two groups: Group 1 (without the use of creatine phosphate) – for the period from 2017 to 2019, the charts of 34 patients who did not undergo hypophosphatemia correction were retrospectively analyzed; Group 2 (with the use of creatine phosphate) – from 2020 to 2024, a prospective analysis of the treatment of 33 patients who underwent hypophosphatemia correction was conducted.
Results. Intravenous administration of creatine phosphate provided a significant increase in phosphorus levels in patients on the 2nd day from 0.57 (0.49; 0.69) mmol/l to 0.78 (0.71; 0.93) mmol/l (p=0.012). And in the group without creatine phosphate administration, a significant increase in phosphorus levels was noted only on the 5th day from 0.59 (0.49; 0.67) mmol/l to 0.91 (0.54; 1.1) mmol/l (p=0.0016).
There were no differences in the duration of stay in the emergency department between the patients of the first and second groups – 8.0 (5.0; 12.0) days versus 11.0 (6.0; 18.0) days (p=0.08) and the duration of hospital stay – 22.0 (17.0; 40.0) days versus 29.0 (21.0; 40.0) days (p=0.31), respectively. Mortality in patients with mild and severe hypophosphatemia did not differ between the groups. Mortality in patients with moderate hypophosphatemia was lower (p=0.039) in the group with creatine phosphate administration 0 (0%) versus 5 (14.7%).
The number of surviving patients with septic shock was higher (p=0.002) in the group with creatine phosphate administration 15 (45.5%) versus 4 (11.8%). However, when analyzing the survival rate using the Kaplan-Meier method, there were no differences between the groups.
Conclusions. Correction of hypophosphatemia can improve treatment outcomes in patients with abdominal sepsis. The expected effect is significant in the group of patients with moderate hypophosphatemia.
Keywords: macronutrients, phosphorus, hypophosphatemia, phosphocreatine, sepsis, abdominal sepsis.
References
1. Blaser AR, Gunst J, Ichai C, Casaer MP, Benstoem C, Besch G, et al. Hypophosphatemia in critically ill adults and children - A systematic review. Clinical Nutrition. 2021 Apr;40(4):1744-1754. doi: http://dx.doi.org/10.1016/j.clnu.2020.09.045
2. Webb A, Angus D, Finfer S, Gattioni L, Singer M. Oxford Textbook of Critical Care. 2rd ed. Oxford: Oxford University Press; 2019. 1960 p.
3. Tebben PJ. Hypophosphatemia: A practical guide to evaluation and management. Endocrine Practice. 2022 Oct;28(10):1091-1099. doi: http://dx.doi.org/10.1016/j.eprac.2022.07.005
4. Kin Sin JC, King L, Ballard E, Llewellyn S, Laupland KB, Tabah A. Hypophosphatemia and outcomes in ICU: a systematic review and meta-analysis. Journal of Intensive Care Medicine. 2021 Sep;36(9):1025-1035. doi: http://dx.doi.org/10.1177/0885066620940274
5. Liu Z, Li T, Du Y, Li C, Chong W. Both hypophosphatemia and hyperphosphatemia are associated with increased mortality in septic patients. Frontiers in Nephrology. 2022 Aug:2:935288. doi: http://dx.doi.org/10.3389/fneph.2022.935288
6. Golubtsov IG, Dudko VA, Marochkov AV, Lipnitskiy AL, Tochilo SA. Hypophosphatemia and outcomes of patients' treatment in the department of anesthesiology and resuscitation of multidisciplinary hospital. Vestnik VGMU. 2023;22(2):54-61. (In Russ.). doi: http://dx.doi.org/10.22263/2312-4156.2023.2.54
7. Markevich DP, Marochkov AV, Livinskaya VA. Dynamics of the content of water-electrolyte exchange in patients with craniocerebral trauma in the perioperative period. Zhurnal Grodnenskogo Gosudarstvennogo Meditsinskogo Universiteta. 2020;18(5):575-583. (In Russ.). doi: http://dx.doi.org/10.25298/2221-8785-2020-18-5-575-583
8. Melchers M, Kouw IWK, Arabi YM, Casaer MP, Cotoia A, Gunst J, et al. Prospective multicenter study to describe the prevalence, outcomes, and management of phosphate disorders in intensive care patients: Study protocol for part B of the international GUTPHOS study. Clinical Nutrition ESPEN. 2024 Oct:63:681-687. doi: http://dx.doi.org/10.1016/j.clnesp.2024.07.024
9. Yaroshetskiy AI, Kuznetsov AV, Petrova MV, Rezepov NA. Hypophosphatemia and reflux syndrome when patients in critical condition resume feeding (literature review). Vestnik Intensivnoi Terapii imeni AI Saltanova. 2019;(2):82-91. (In Russ.). doi: http://dx.doi.org/10.21320/1818-474X-2019-2-82-91
10. Volkov MM, Kayukov IG, Smirnov AV. Phosphorocalcium exchange and its regulation. Nefrologiya. 2010;14(1):91-103. (In Russ.).
11. Imel EA, Econs MJ. Approach to the hypophosphatemic patient. The Journal of Clinical Endocrinology and Metabolism. 2012 Mar;97(3):696-706. doi: http://dx.doi.org/10.1210/jc.2011-1319
12. Felsenfeld AJ, Levine BS. Approach to treatment of hypophosphatemia. American Journal of Kidney Diseases. 2012 Oct;60(4):655-661. doi: http://dx.doi.org/10.1053/j.ajkd.2012.03.024
13. Tebben PJ. Hypophosphatemia: A Practical Guide to Evaluation and Management. Endocrine Practice. 2022 Oct;28(10):1091-1099. doi: http://dx.doi.org/10.1016/j.eprac.2022.07.005
14. Charron T, Bernard F, Skrobik Y, Simoneau N, Gagnon N, Leblanc M. Intravenous phosphate in the intensive care unit: more aggressive repletion regimens for moderate and severe hypophosphatemia. Intensive Care Medicine. doi: http://dx.doi.org/10.1007/s00134-003-1872-2
15. Nartaylakov MA, Salimgareev IZ, Panteleev VS, Nagaev FR, Pogadaev VV, Rezyapov VV, i dr. Reflux syndrome in patients with a surgical profile. Analiz Klinicheskikh Sluchaev Kreativnaya Khirurgiya i Onkologiya. 2019;9(2):118-124. (In Russ.). doi: http://dx.doi.org/10.24060/2076-3093-2019-9-2-118-124
Submitted 20.11.2025
Accepted 10.12.2025
Information about authors:
Siarhei A. Tachyla – Candidate of Medical Sciences, associate professor, anesthesiologist-resuscitator of the anesthesiology & resuscitation department, Mogilev Regional Clinical Hospital; head of the branch of the Chairs of Anesthesiology & Resuscitation and Hospital Surgery with the course of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University, https://orcid.org/0000-0003-1659-5902
A.V. Marochkov – Doctor of Medical Sciences, professor, anesthesiologist-resuscitator of the anesthesiology and resuscitation department, Mogilev Regional Clinical Hospital; professor of the branch of the Chairs of Anesthesiology & Resuscitation and Hospital Surgery with the course of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University, https://orcid.org/0000-0001-5092-8315
D.A. Yakimov – Candidate of Medical Sciences, otorhinolaryngologist of the otorhinolaryngology department, Mogilev Regional Clinical Hospital; associate professor of the branch of the Chairs of Anesthesiology & Resuscitation and Hospital Surgery with the course of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University, https://orcid.org/0000-0002-4655-9833
N.N. Hapeyeva – intern, anesthesiologist-resuscitator of the anesthesiology & resuscitation department, Mogilev Regional Clinical Hospital, https://orcid.org/0009-0003-7146-5438
