ArticleCureus2021
Impact of Phosphatemia Variability in Neurological Outcomes in Patients With Spontaneous Subarachnoid Hemorrhage.
Article in Cureus, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed, 2 citations in OpenAlex.
- Dynamic sodium dysregulation predicts mortality in intracerebral hemorrhage: A retrospective cohort study of temporal variability and absolute thresholds.Neurosurgical review · 2025Article
- Refeeding Syndrome.Deutsches Arzteblatt international · 2023Review
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionElectrolyte disturbances, such as dysnatremia, hypokalemia, and hypomagnesemia, are frequently observed during acute spontaneous subarachnoid hemorrhage (sSAH). However, there are limited data concerning hypophosphatemia.
objectiveTo analyze the frequency of phosphate (Pi) disturbances in sSAH patients and assess their influence on neurological outcomes compared with that in patients without sSAH.
methodsWe conducted a retrospective study of patients with sSAH admitted to a neurocritical care unit in two years. We also included nonneurocritical patients admitted to a general intensive care unit (ICU). Serum Pi levels and daily Pi repletion data were collected during the first 10 days after admission. The primary endpoint was neurologic outcome using the Glasgow Outcome Scale at six months (GOS-6M) and the Glasgow Coma Scale at ICU discharge (GCS-ICUd). The effect of phosphatemia variability on mortality and ICU length of stay (ICU-LOS) was also analyzed.
resultsPatients with sSAH had lower mean Pi level and median Pi dose repletion than that of nonneurocritical patients (3.1 ± 0.4 vs. 3.9 ± 1.3, p < 0.001). In the sSAH group, patients with hypophosphatemia had lower GCS-ICUd (12 ± 3.3 vs. 14 ± 2.4). Also, GOS-6M was lower in patients with hypophosphatemia but was not statistically significant (p = 0.09). By contrast, a higher mean Pi level in nonneurocritical patients was significantly associated with higher ICU mortality (4.8 ± 1.6 mg/dL vs. 3.6 ± 1.0 mg/dL, p = 0.003) and higher ICU-LOS (r = 0.231, p = 0.028). In the sSAH group, we found the opposite. In a multivariate analysis of the sSAH group, the increase in the Pi level was associated with higher GCS-ICUd (unstandardized coefficient in multiple linear regression [B] 1.79; 95% CI 0.43-3.15). The opposite was found in nonneurocritical patients. A Pi concentration higher than 2.5 mg/dL was associated with a better GCS-ICUd. We also found that creatinine, urea, chloride, need for Pi substitution, therapy intensity level, and pH were independent predictors of the mean Pi level during ICU stay in the sSAH group.
conclusionsPatients with sSAH had lower mean Pi levels and required significantly higher daily Pi replacement compared with those of nonneurocritical patients. Since hypophosphatemia may be associated with poor neurological outcomes, patients with sSAH need cautious phosphate repletion.
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