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Elevated Initial Serum Phosphate Levels Predict Higher Mortality and Impaired Neurological Outcome in Cardiac Arrest Patients with Return of Spontaneous Circulation

Purpose: Although a moderate proportion of cardiac arrest (CA) patients achieve a return of spontaneous circulation (ROSC), few survive to discharge, mostly with poor neurological development. As serum phosphate levels were described as elevated after cardiopulmonary resuscitation (CPR), we asked wh...

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Autores principales: Duse, Dragos Andrei, Gröne, Michael, Kramser, Nicolas, Ortkemper, Matthias, Quast, Christine, Voß, Fabian, Heramvand, Nadia, Kostev, Karel, Kelm, Malte, Horn, Patrick, Jung, Christian, Erkens, Ralf
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9914872/
https://www.ncbi.nlm.nih.gov/pubmed/36766585
http://dx.doi.org/10.3390/diagnostics13030479
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author Duse, Dragos Andrei
Gröne, Michael
Kramser, Nicolas
Ortkemper, Matthias
Quast, Christine
Voß, Fabian
Heramvand, Nadia
Kostev, Karel
Kelm, Malte
Horn, Patrick
Jung, Christian
Erkens, Ralf
author_facet Duse, Dragos Andrei
Gröne, Michael
Kramser, Nicolas
Ortkemper, Matthias
Quast, Christine
Voß, Fabian
Heramvand, Nadia
Kostev, Karel
Kelm, Malte
Horn, Patrick
Jung, Christian
Erkens, Ralf
author_sort Duse, Dragos Andrei
collection PubMed
description Purpose: Although a moderate proportion of cardiac arrest (CA) patients achieve a return of spontaneous circulation (ROSC), few survive to discharge, mostly with poor neurological development. As serum phosphate levels were described as elevated after cardiopulmonary resuscitation (CPR), we asked whether these elevations would predict a higher risk of mortality and impaired neurological outcome in CA patients following ROSC. Methods: Initial serum phosphate levels, survival, and neurologic status at discharge of 488 non-traumatic CA patients treated at a single German hospital after achieving ROSC were analyzed. The cut-off value of phosphate for mortality prediction was determined using the receiver operator characteristic (ROC) curve, and patients were divided accordingly for comparison. Results were validated by analyzing phosphate levels in a multi-centric cohort containing 3299 CA patients from the eICU database of the United States. Results: In the German cohort, ROC analysis showed a 90% specificity for phosphate levels >2.7 mmol/L to predict mortality (AUC: 0.76, p < 0.0001), and phosphate level elevations were associated with higher in-hospital mortality (crude odds ratio 3.04, 95% CI 2.32 to 4.08). Patients with initial phosphate levels >2.7 mmol/L had significantly higher mortality in both analyzed collectives (p < 0.0001). Similarly, patients from the German cohort who initially had higher phosphate levels also showed a higher proportion of impaired neurological status at discharge and morphological signs of brain injury. Conclusions: In CA patients following ROSC, initial serum phosphate levels >2.7 mmol/L predict higher mortality and impaired neurological outcome. Our data suggests that phosphate determination might improve the preciseness of the overall and neurologic prognostication in patients after CPR following ROSC.
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spelling pubmed-99148722023-02-11 Elevated Initial Serum Phosphate Levels Predict Higher Mortality and Impaired Neurological Outcome in Cardiac Arrest Patients with Return of Spontaneous Circulation Duse, Dragos Andrei Gröne, Michael Kramser, Nicolas Ortkemper, Matthias Quast, Christine Voß, Fabian Heramvand, Nadia Kostev, Karel Kelm, Malte Horn, Patrick Jung, Christian Erkens, Ralf Diagnostics (Basel) Article Purpose: Although a moderate proportion of cardiac arrest (CA) patients achieve a return of spontaneous circulation (ROSC), few survive to discharge, mostly with poor neurological development. As serum phosphate levels were described as elevated after cardiopulmonary resuscitation (CPR), we asked whether these elevations would predict a higher risk of mortality and impaired neurological outcome in CA patients following ROSC. Methods: Initial serum phosphate levels, survival, and neurologic status at discharge of 488 non-traumatic CA patients treated at a single German hospital after achieving ROSC were analyzed. The cut-off value of phosphate for mortality prediction was determined using the receiver operator characteristic (ROC) curve, and patients were divided accordingly for comparison. Results were validated by analyzing phosphate levels in a multi-centric cohort containing 3299 CA patients from the eICU database of the United States. Results: In the German cohort, ROC analysis showed a 90% specificity for phosphate levels >2.7 mmol/L to predict mortality (AUC: 0.76, p < 0.0001), and phosphate level elevations were associated with higher in-hospital mortality (crude odds ratio 3.04, 95% CI 2.32 to 4.08). Patients with initial phosphate levels >2.7 mmol/L had significantly higher mortality in both analyzed collectives (p < 0.0001). Similarly, patients from the German cohort who initially had higher phosphate levels also showed a higher proportion of impaired neurological status at discharge and morphological signs of brain injury. Conclusions: In CA patients following ROSC, initial serum phosphate levels >2.7 mmol/L predict higher mortality and impaired neurological outcome. Our data suggests that phosphate determination might improve the preciseness of the overall and neurologic prognostication in patients after CPR following ROSC. MDPI 2023-01-28 /pmc/articles/PMC9914872/ /pubmed/36766585 http://dx.doi.org/10.3390/diagnostics13030479 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Duse, Dragos Andrei
Gröne, Michael
Kramser, Nicolas
Ortkemper, Matthias
Quast, Christine
Voß, Fabian
Heramvand, Nadia
Kostev, Karel
Kelm, Malte
Horn, Patrick
Jung, Christian
Erkens, Ralf
Elevated Initial Serum Phosphate Levels Predict Higher Mortality and Impaired Neurological Outcome in Cardiac Arrest Patients with Return of Spontaneous Circulation
title Elevated Initial Serum Phosphate Levels Predict Higher Mortality and Impaired Neurological Outcome in Cardiac Arrest Patients with Return of Spontaneous Circulation
title_full Elevated Initial Serum Phosphate Levels Predict Higher Mortality and Impaired Neurological Outcome in Cardiac Arrest Patients with Return of Spontaneous Circulation
title_fullStr Elevated Initial Serum Phosphate Levels Predict Higher Mortality and Impaired Neurological Outcome in Cardiac Arrest Patients with Return of Spontaneous Circulation
title_full_unstemmed Elevated Initial Serum Phosphate Levels Predict Higher Mortality and Impaired Neurological Outcome in Cardiac Arrest Patients with Return of Spontaneous Circulation
title_short Elevated Initial Serum Phosphate Levels Predict Higher Mortality and Impaired Neurological Outcome in Cardiac Arrest Patients with Return of Spontaneous Circulation
title_sort elevated initial serum phosphate levels predict higher mortality and impaired neurological outcome in cardiac arrest patients with return of spontaneous circulation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9914872/
https://www.ncbi.nlm.nih.gov/pubmed/36766585
http://dx.doi.org/10.3390/diagnostics13030479
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