Association Between Admission Serum Phosphate Level and All-Cause Mortality Among Patients with Spontaneous Intracerebral Hemorrhage

Abstract

Background: Hypophosphatemia was reported to frequently occur in patients with nontraumatic intracranial hemorrhage (ICH); however, the correlation between hypophosphatemia and outcomes of ICH remains unclear. This study aimed to examine the association between admission serum phosphate and all-cause mortality among patients with mildmoderate spontaneous ICH (sICH). Methods: A total of 851 patients with sICH were enrolled. Serum phosphate was acquired within 24 hours on admission, and participants were divided according to phosphate quartiles. The primary outcome was all-cause mortality within 90 days, and univariate and multivariate models were employed to estimate the mortality risk. Results: There were significant differences among sICH patients with different phosphate quartiles in terms of age, diastolic blood pressure (DBP), activated partial thromboplastin time (APTT), platelet count, and incidence of respiratory failure events on admission (P < 0.05). Log rank test showed a significant difference in the mortality risk among sICH patients with each phosphate quartile. Univariate Cox regression analysis revealed that age, smoking, DBP, APTT, NIH stroke scale (NIHSS) score, hematoma volume and serum phosphate might be associated with the 90-day all-cause mortality in patients with sICH (P < 0.05). Multivariable Cox regression analysis showed that the crude mortality was 4.3-fold greater in sICH patients with serum phosphate Q1 than those with Q4 (P < 0.001), and remained 3.18-fold higher after adjusting for age, smoking, DBP, APTT, NIHSS score, hematoma volume and early withdrawal of life-sustaining therapy (P = 0.011). Representative operating curve (ROC) analysis showed that admission serum phosphate was predictable for all-cause mortality within 90 days in patients with sICH (area under the ROC = 0.628, P < 0.001). Conclusion:Low admission serum phosphate is strongly associated with a high risk of mortality in patients with mild-moderate sICH, and hypophosphatemia may be a prognostic marker for all-cause mortality in patients with mild-moderate sICH.

Development, Design and Utilization of a CDSS for Refeeding Syndrome in Real Life Inpatient Care—A Feasibility Study

“…FP patients were mostly detected due to renal replacement therapy or brain surgery with pending OPS coding, intracerebral hemorrhages or head injuries or end-stage liver disease. These procedures and comorbidities have already been described as causing electrolyte imbalances resembling RFS without reference to nutrition status [16][17][18][19]26]. These confounders are included in the clinical information presented by the CDSS user interface (see Table S1 in the Supplementary Materials).…”

“…Alert suppression was performed in the case of detection of ketones in urine (diabetic ketoacidosis), paracetamol in serum (paracetamol intoxication), phosphate or magnesium concentrations above the upper reference range (severe acute or chronic renal failure), parathyroid hormone concentrations above the upper reference range (hyperparathyroidism) or lung or neuroendocrine malignancies (secretion of parathyroid hormone-related peptide) in the patients' laboratory data before RFS-susceptible electrolyte imbalance (for detailed information on used cut-offs and lab values for exclusion, see Table S2 in Supplement). These comorbidities are known to induce hypophosphatemia without association to RFS [16][17][18][19][20].…”

The association between serum phosphate and length of hospital stay and all-cause mortality in adult patients: a cross-sectional study

“…Varied definitions of phosphate abnormality: the cut-off value for hypophosphatemia varied from 0.6 to 1.09 mmol/L [ 7 , 14 , 15 , 18 , 24 , 44 ], and the cut-off value for hyperphosphatemia varied from 1.23 to 1.94mmol/L [ 15 , 18 , 24 , 44 , 49 ]. Besides, some studies used the lowest or highest quartile of serum phosphate as the low or high phosphate level [ 50 ]. As normal serum phosphate levels ranged from 0.8 to 1.45mmol/L in adults and inflection point of 1.16mmol/L in serum phosphate level was observed in our study, hypophosphatemia and hyperphosphatemia were defined as serum phosphate level < 0.8mmol/L (G1 and G2) and ≥1.45mmol/L (G5), respectively, and G4 (iP 1.16-1.45mmol/L) was regarded as reference.…”

“…[ 2 ]. Different study populations: as most of the previous studies were performed in critically ill patients [ 7 , 16 , 44 , 48 ], or trauma patients [ 50 ] or sepsis patients [ 14 , 18 , 49 ], the effects of admission hypophosphatemia on mortality or other adverse outcomes could be easily concealed or eliminated by the severity of diseases.…”

Association between serum phosphate and in-hospital mortality of patients with AECOPD: A retrospective analysis on eICU database

“…Phosphorus is involved in various aspects of physiological processes, including energy metabolism, bone mineralization, membrane transport, and intracellular signaling [ [10] , [11] , [12] , [13] ]. Numerous studies have shown that higher serum phosphate level is associated with increased mortality in many diseases [ [14] , [15] , [16] , [17] , [18] ]. Recently, a few studies have indicated that the serum phosphate level is related to the severity and outcomes of COPD [ 19 , 20 ].…”