Early phosphate changes as potential indicator of unreadiness for artificial feeding: a secondary analysis of the EPaNIC randomized controlled trial (RCT)
Authors' conclusion
Development of RHP may identify patients who are particularly harmed by early PN.
Study context
- Population
- Critically ill intensive care unit (ICU) patients in the EPaNIC RCT with available phosphate measurements
- Participants
- 3,520 available phosphate measurements
- Comparison
- Relative hypophosphatemia (RHP) vs Without RHP
- Primary endpoint
- Interaction of AHP, RHP or CHP with randomised nutritional strategy for impact on outcome (likelihood of earlier discharge alive from ICU)
Methodological detailssubgroup interaction analysis, adjusted for risk factors
- Subgroup interaction analysis
- Adjusted for risk factors
Primary result
As reported in the abstract
Earlier discharge alive from ICU, Early PN vs late PN
Adjusted hazard ratio (CI)
RHP: Early PN
0.75(0.65–0.87)
Without RHP: Early PN
0.93(0.86–1.00)
- RHP, but not absolute hypophosphatemia (AHP) or CHP, interacted with the randomized intervention
- P = 0.01
Further findings
Incidence of hypophosphatemia types
- AHP (< 0.65 mmol/L on second ICU-day)
- 9.1%
- RHP
- 23.7%
- CHP (combination of AHP and RHP)
- 5.3%
Prediction of RHP by admission characteristics
- Adjusted pseudo R-squared (poor prediction)
- 1.7%
Original publication
Early phosphate changes as potential indicator of unreadiness for artificial feeding: a secondary analysis of the EPaNIC RCT. Crit Care. Published 28 January 2025. doi:10.
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