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Impact of Phosphatemia Variability in Neurological Outcomes in Patients With Spontaneous Subarachnoid Hemorrhage

Introduction: Electrolyte disturbances, such as dysnatremia, hypokalemia, and hypomagnesemia, are frequently observed during acute spontaneous subarachnoid hemorrhage (sSAH). However, there are limited data concerning hypophosphatemia. Objective: To analyze the frequency of phosphate (Pi) disturbanc...

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Autores principales: Varudo, Rita, Mota, Ana Marta, Pereira, Eduarda, Dias, Celeste
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8544909/
https://www.ncbi.nlm.nih.gov/pubmed/34722043
http://dx.doi.org/10.7759/cureus.18257
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author Varudo, Rita
Mota, Ana Marta
Pereira, Eduarda
Dias, Celeste
author_facet Varudo, Rita
Mota, Ana Marta
Pereira, Eduarda
Dias, Celeste
author_sort Varudo, Rita
collection PubMed
description Introduction: Electrolyte disturbances, such as dysnatremia, hypokalemia, and hypomagnesemia, are frequently observed during acute spontaneous subarachnoid hemorrhage (sSAH). However, there are limited data concerning hypophosphatemia. Objective: To analyze the frequency of phosphate (Pi) disturbances in sSAH patients and assess their influence on neurological outcomes compared with that in patients without sSAH. Methods: We 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. Results: Patients 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. Conclusions: Patients 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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spelling pubmed-85449092021-10-28 Impact of Phosphatemia Variability in Neurological Outcomes in Patients With Spontaneous Subarachnoid Hemorrhage Varudo, Rita Mota, Ana Marta Pereira, Eduarda Dias, Celeste Cureus Emergency Medicine Introduction: Electrolyte disturbances, such as dysnatremia, hypokalemia, and hypomagnesemia, are frequently observed during acute spontaneous subarachnoid hemorrhage (sSAH). However, there are limited data concerning hypophosphatemia. Objective: To analyze the frequency of phosphate (Pi) disturbances in sSAH patients and assess their influence on neurological outcomes compared with that in patients without sSAH. Methods: We 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. Results: Patients 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. Conclusions: Patients 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. Cureus 2021-09-24 /pmc/articles/PMC8544909/ /pubmed/34722043 http://dx.doi.org/10.7759/cureus.18257 Text en Copyright © 2021, Varudo et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Emergency Medicine
Varudo, Rita
Mota, Ana Marta
Pereira, Eduarda
Dias, Celeste
Impact of Phosphatemia Variability in Neurological Outcomes in Patients With Spontaneous Subarachnoid Hemorrhage
title Impact of Phosphatemia Variability in Neurological Outcomes in Patients With Spontaneous Subarachnoid Hemorrhage
title_full Impact of Phosphatemia Variability in Neurological Outcomes in Patients With Spontaneous Subarachnoid Hemorrhage
title_fullStr Impact of Phosphatemia Variability in Neurological Outcomes in Patients With Spontaneous Subarachnoid Hemorrhage
title_full_unstemmed Impact of Phosphatemia Variability in Neurological Outcomes in Patients With Spontaneous Subarachnoid Hemorrhage
title_short Impact of Phosphatemia Variability in Neurological Outcomes in Patients With Spontaneous Subarachnoid Hemorrhage
title_sort impact of phosphatemia variability in neurological outcomes in patients with spontaneous subarachnoid hemorrhage
topic Emergency Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8544909/
https://www.ncbi.nlm.nih.gov/pubmed/34722043
http://dx.doi.org/10.7759/cureus.18257
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