Associations of severe hypophosphatemia and clinical outcomes in mechanically ventilated children with dengue shock syndrome

Hypophosphatemia is common in critically ill children, but its clinical implications in dengue shock syndrome (DSS) remain uncertain. This retrospective single-center study, conducted in 2022 at a tertiary pediatric intensive care unit in Vietnam, investigated the association between marked phosphorus reduction and clinical outcomes in children with DSS requiring mechanical ventilation (MV). Fifty-seven children with DSS on MV and complete phosphorus profiles were enrolled. Propensity score matching adjusted for key confounders including age, serum calcium, metabolic acidosis, and creatinine levels. The primary outcome was in-hospital mortality; secondary outcomes included the duration of MV and vasopressor use. Stepwise logistic and linear regression analyses were applied. The median patient age was 6 years (interquartile range [IQR]: 4-9). Twenty-one patients (37%) developed severe hypophosphatemia during pediatric intensive care unit admission. Overall mortality was 28% (16/57). Median MV duration was 5 days (IQR: 3-6), and vasopressor support lasted a median of 3 days (IQR: 1-5). While severe hypophosphatemia was not associated with mortality, it was significantly correlated with prolonged MV and vasopressor requirements. These findings suggest that severe hypophosphatemia may contribute to extended organ support. Timely recognition and correction of phosphorus deficits could provide potential clinical benefits in this vulnerable population.