{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T07:07:26Z","timestamp":1789542446357,"version":"build-2803163510"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":257,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acute Medicine &amp;amp; Surgery"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Serum phosphate abnormalities are common in sepsis, yet associations with outcomes remain inconsistent. We examined day\u2010specific associations between serum phosphate levels during the first week after intensive care unit (ICU) admission and 90\u2010day mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single\u2010center retrospective study included adults meeting Sepsis\u20103 criteria admitted to the ICU between April 2011 and March 2021 with at least one serum phosphate measurement on Days 1\u20137. Phosphate was categorized as low (\u2264\u20090.84\u2009mmol\/L [\u2264\u20092.6\u2009mg\/dL]), normal (0.87\u20131.45\u2009mmol\/L [2.7\u20134.5\u2009mg\/dL]), or high (\u2265\u20091.49\u2009mmol\/L [\u2265\u20094.6\u2009mg\/dL]). Day\u2010specific landmark Cox models assessed 90\u2010day mortality using the normal group as reference and adjusted for age, sex, body mass index, arterial pH, daily Sequential Organ Failure Assessment (SOFA) score excluding the central nervous system component, renal replacement therapy status, and previous\u2010day phosphate supplementation on Days 2\u20137. Day\u2010specific logistic models evaluated factors associated with phosphate abnormalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 480 patients, hyperphosphatemia was consistently associated with higher 90\u2010day mortality across Days 1\u20137 after adjustment. Hypophosphatemia showed phase\u2010dependent associations that attenuated after adjustment. Arterial pH was most strongly associated with phosphate abnormalities early, whereas SOFA score showed more consistent associations later.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Hyperphosphatemia during the first ICU week was consistently associated with increased 90\u2010day mortality, whereas associations with hypophosphatemia were weaker after adjustment. The prevalence and clinical correlates of phosphate abnormalities varied across days, supporting interpretation by measurement timing and clinical severity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ams2.70161","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:55:49Z","timestamp":1789541749000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Day\u2010Specific Associations of Serum Phosphate With 90\u2010Day Mortality in Adult Patients With sepsis: A Landmark Analysis"],"prefix":"10.1002","volume":"13","author":[{"given":"Yugo","family":"Matsumoto","sequence":"first","affiliation":[{"name":"Emergency and Intensive Care Unit Shiga University of Medical Science  Otsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5990-0498","authenticated-orcid":false,"given":"Tomoki","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Critical and Intensive Care Medicine Shiga University of Medical Science  Otsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5511-6041","authenticated-orcid":false,"given":"Kazunori","family":"Fujino","sequence":"additional","affiliation":[{"name":"Department of Critical and Intensive Care Medicine Shiga University of Medical Science  Otsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuka","family":"Segoe","sequence":"additional","affiliation":[{"name":"Emergency and Intensive Care Unit Shiga University of Medical Science  Otsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuhiro","family":"Fujino","sequence":"additional","affiliation":[{"name":"Department of Critical and Intensive Care Medicine Shiga University of Medical Science  Otsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7358-0769","authenticated-orcid":false,"given":"Hidemitsu","family":"Miyatake","sequence":"additional","affiliation":[{"name":"Department of Critical and Intensive Care Medicine Shiga University of Medical Science  Otsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoto","family":"Mizumura","sequence":"additional","affiliation":[{"name":"Emergency and Intensive Care Unit Shiga University of Medical Science  Otsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junji","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Emergency and Intensive Care Unit Shiga University of Medical Science  Otsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4100-2099","authenticated-orcid":false,"given":"Takuma","family":"Kishimoto","sequence":"additional","affiliation":[{"name":"Department of Critical and Intensive Care Medicine Shiga University of Medical Science  Otsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1981-2028","authenticated-orcid":false,"given":"Yasuyuki","family":"Tsujita","sequence":"additional","affiliation":[{"name":"Emergency and Intensive Care Unit Shiga University of Medical Science  Otsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoto","family":"Shiomi","sequence":"additional","affiliation":[{"name":"Emergency and Intensive Care Unit Shiga University of Medical Science  Otsu Japan"},{"name":"Department of Critical and Intensive Care Medicine Shiga University of Medical Science  Otsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"issue":"8","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis\u20103)","volume":"315","author":"Singer M.","year":"2016","journal-title":"Journal of the American Medical Association"},{"issue":"10219","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, Regional, and National Sepsis Incidence and Mortality, 1990\u20102017: Analysis for the Global Burden of Disease Study","volume":"395","author":"Rudd K. E.","year":"2020","journal-title":"Lancet (London, England)"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ebiom.2022.104394","article-title":"Sepsis Biomarkers and Diagnostic Tools With a Focus on Machine Learning","volume":"86","author":"Komorowski M.","year":"2022","journal-title":"eBioMedicine"},{"issue":"1","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00223-020-00686-3","article-title":"Phosphate Metabolism in Health and Disease","volume":"108","author":"Peacock M.","year":"2021","journal-title":"Calcified Tissue International"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1146\/annurev.med.051308.111339","article-title":"Regulation of Phosphate Homeostasis by PTH, Vitamin D, and FGF23","volume":"61","author":"Bergwitz C.","year":"2010","journal-title":"Annual Review of Medicine"},{"issue":"1","key":"e_1_2_11_7_1","first-page":"67","article-title":"Severe Hypophosphatemia in Sepsis as a Mortality Predictor","volume":"36","author":"Shor R.","year":"2006","journal-title":"Annals of Clinical and Laboratory Science"},{"issue":"9","key":"e_1_2_11_8_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-044473","article-title":"Association Between Serum Phosphate and Mortality in Critically Ill Patients: A Large Retrospective Cohort Study","volume":"11","author":"Chen Y.","year":"2021","journal-title":"BMJ Open"},{"key":"e_1_2_11_9_1","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2022.728887","article-title":"Effect of Serum Phosphate on the Prognosis of Septic Patients: A Retrospective Study Based on MIMIC\u2010IV Database","volume":"9","author":"Li Z.","year":"2022","journal-title":"Front Med (Lausanne)"},{"issue":"4","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/j.jcrc.2012.10.011","article-title":"Hypophosphatemia in Critically Ill Patients","volume":"28","author":"Suzuki S.","year":"2013","journal-title":"Journal of Critical Care"},{"issue":"1","key":"e_1_2_11_11_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0190978","article-title":"Hyperphosphatemia Is Associated With High Mortality in Severe Burns","volume":"13","author":"Kuo G.","year":"2018","journal-title":"PLoS One"},{"issue":"9","key":"e_1_2_11_12_1","doi-asserted-by":"crossref","DOI":"10.3390\/diagnostics11091548","article-title":"ICU\u2010Admission Hyperphosphataemia Is Related to Shock and Tissue Damage, Indicating Injury Severity and Mortality in Polytrauma Patients","volume":"11","author":"Rugg C.","year":"2021","journal-title":"Diagnostics"},{"key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.resuscitation.2018.04.026","article-title":"Prognostic Value of Serum Phosphate Level in Adult Patients Resuscitated From Cardiac Arrest","volume":"128","author":"Jung Y. 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H.","year":"2020","journal-title":"Emergency Medicine Journal"},{"key":"e_1_2_11_17_1","doi-asserted-by":"crossref","DOI":"10.7717\/peerj.16241","article-title":"Prognostic Value of Serum Phosphate Levels in Sepsis: A Systematic Review and Meta\u2010Analysis","volume":"11","author":"Wei S.","year":"2023","journal-title":"PeerJ"},{"issue":"5","key":"e_1_2_11_18_1","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1002\/ueg2.12059","article-title":"Serum Phosphate Is Associated With Mortality Among Patients Admitted to ICU for Acute Pancreatitis","volume":"9","author":"Hedjoudje A.","year":"2021","journal-title":"United European Gastroenterology Journal"},{"issue":"3","key":"e_1_2_11_19_1","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1038\/ncpneph0124","article-title":"Hypophosphatemia: An Evidence\u2010Based Approach to Its Clinical Consequences and Management","volume":"2","author":"Amanzadeh J.","year":"2006","journal-title":"Nature Clinical Practice. Nephrology"}],"container-title":["Acute Medicine &amp; Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ams2.70161","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ams2.70161","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ams2.70161","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:55:52Z","timestamp":1789541752000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ams2.70161"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1002\/ams2.70161"],"URL":"https:\/\/doi.org\/10.1002\/ams2.70161","archive":["Portico"],"relation":{},"ISSN":["2052-8817","2052-8817"],"issn-type":[{"value":"2052-8817","type":"print"},{"value":"2052-8817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-02-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70161"}}