Özden Y, Buyukberber NM. Admission hyperphosphatemia as a predictor of severity and mortality in acute pancreatitis: A 1000-patient cohort study. World J Gastrointest Surg 2026; 18(1): 114227 [DOI: 10.4240/wjgs.v18.i1.114227]
Corresponding Author of This Article
Yavuz Özden, MD, Department of Gastroenterology, Kayseri City Hospital, University of Health Sciences, Şeker District, Muhsin Yazıcıoğlu Boulevard No. 77 Kocasinan, Kayseri 38080, Türkiye. yavuzozden@gmail.com
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Gastroenterology & Hepatology
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Retrospective Cohort Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 27, 2026 (publication date) through Jan 28, 2026
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World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Özden Y, Buyukberber NM. Admission hyperphosphatemia as a predictor of severity and mortality in acute pancreatitis: A 1000-patient cohort study. World J Gastrointest Surg 2026; 18(1): 114227 [DOI: 10.4240/wjgs.v18.i1.114227]
World J Gastrointest Surg. Jan 27, 2026; 18(1): 114227 Published online Jan 27, 2026. doi: 10.4240/wjgs.v18.i1.114227
Admission hyperphosphatemia as a predictor of severity and mortality in acute pancreatitis: A 1000-patient cohort study
Yavuz Özden, Nuh Mehmet Buyukberber
Yavuz Özden, Nuh Mehmet Buyukberber, Department of Gastroenterology, Kayseri City Hospital, University of Health Sciences, Kayseri 38080, Türkiye
Author contributions: Özden Y contributed to conceptualization, data acquisition, data analysis and interpretation, manuscript drafting, critical revision of the manuscript, and overall supervision; Buyukberber NM contributed to methodology, validation, data interpretation, and critical review of the final manuscript. All authors have read and approved the final version of the manuscript and agreed to be accountable for all aspects of the work.
Institutional review board statement: The study protocol was approved by the Ethics Committee of the University of Health Sciences, Kayseri City Hospital (Approval No: 2025/288) and complied with the principles of the Declaration of Helsinki.
Informed consent statement: The requirement for informed consent was waived due to the retrospective nature of the study. All patient data were anonymized prior to analysis.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest related to this study.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yavuz Özden, MD, Department of Gastroenterology, Kayseri City Hospital, University of Health Sciences, Şeker District, Muhsin Yazıcıoğlu Boulevard No. 77 Kocasinan, Kayseri 38080, Türkiye. yavuzozden@gmail.com
Received: September 16, 2025 Revised: October 22, 2025 Accepted: November 27, 2025 Published online: January 27, 2026 Processing time: 129 Days and 12.4 Hours
Abstract
BACKGROUND
Although most acute pancreatitis (AP) cases are mild, up to 20% progress to severe disease, leading to substantial morbidity and mortality. Early risk stratification remains challenging because conventional scoring systems require multiple parameters and often depend on 24-48 hours of observation.
AIM
To evaluate whether serum phosphate levels measured upon hospital admission can predict disease severity and short-term clinical outcomes in patients with AP.
METHODS
We retrospectively analyzed 1000 consecutive patients hospitalized for AP between November 2023 and June 2025. Admission phosphate was categorized as hypophosphatemia (< 2.5 mg/dL), normophosphatemia (2.5-4.5 mg/dL), or hyperphosphatemia (> 4.5 mg/dL). Clinical outcomes included severe AP (SAP), pancreatic necrosis, intensive care unit (ICU) admission, and 30-day all-cause mortality. Multivariable logistic regression was performed to evaluate the independent association between phosphate levels and clinical outcomes, with additional models adjusted for creatinine levels and acute kidney injury (AKI).
RESULTS
SAP occurred in 60% of patients with hyperphosphatemia and in 20% of those with normophosphatemia (P < 0.001). Pancreatic necrosis (50% vs 10%) and ICU admission (70% vs 15%) were also significantly more frequent in the hyperphosphatemia group. Thirty-day mortality was 25% in the hyperphosphatemia group and 3% in the normophosphatemia group. Hyperphosphatemia independently predicted 30-day mortality (adjusted OR 5.8; 95%CI: 2.9-11.5; P < 0.001), and this association remained significant after adjustment for creatinine and AKI (adjusted OR 4.7; 95%CI: 2.1-10.3; P < 0.001).
CONCLUSION
Admission hyperphosphatemia independently predicts severe disease, pancreatic necrosis, ICU admission, and early mortality, highlighting a simple and inexpensive biomarker to support rapid risk stratification in AP.
Core Tip: Early risk stratification in acute pancreatitis remains a major clinical challenge, as conventional scoring systems require up to 48 hours and limit decision-making in the emergency setting. In this large 1000-patient cohort, admission hyperphosphatemia was strongly associated with severe disease, pancreatic necrosis, intensive care requirement, and 30-day mortality and was identified as an independent predictor of poor outcomes. These findings suggest that serum phosphate is an inexpensive, readily available biomarker that may complement existing tools and enable the prompt identification of high-risk patients at hospital admission.
