Hypophosphatemia after nontraumatic intracranial hemorrhage

Junttila, Eija; Koskenkari, Juha; Ala‐Kokko, Tero

doi:10.1111/aas.12903

Cited by 15 publications

(38 citation statements)

References 30 publications

(44 reference statements)

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“…Given that hypophosphatemia was variably defined among studies, sensitivity analysis was subsequently performed on different hypophosphatemia thresholds defined by the authors. Studies that performed their analysis based on a definition of serum phosphate level ≤0.80 mmol/L 15,16,30 –32,34 –36 showed some evidence for a higher risk of mortality in the group of patients with hypophosphatemia compared to those without (RR, 1.27 [95% CI, 1.00-1.60]; P = .048; Table 2). The remainder 4 studies that performed their analyses with serum phosphate level of >0.80 mmol/L 28 –30,33 did not demonstrate a statistically significant result (RR, 0.97 [95% CI, 0.78-1.21]; P = .81; Online Appendix E and F).…”

Section: Resultsmentioning

confidence: 99%

Hypophosphatemia and Outcomes in ICU: A Systematic Review and Meta-Analysis

Sin

King

Ballard

et al. 2020

J Intensive Care Med

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Purpose: Hypophosphatemia is reported in up to 5% of hospitalized patients and ranges from 20% to 80% in critically ill patients. The consequences of hypophosphatemia for critically ill patients remain controversial. We evaluated the effect of hypophosphatemia on mortality and length of stay in intensive care unit (ICU) patients. Methods: MEDLINE, EMBASE, Cochrane Library (Reviews and Trials), and PubMed were searched for articles in English. The primary outcome was mortality and secondary outcome was length of stay. The quality of evidence was graded using a modified Newcastle-Ottawa Scale. Results: Our search yielded 828 articles and ultimately included 12 studies with 7626 participants in the analysis. Hypophosphatemia was associated with increased hospital length of stay (2.19 days [95% CI, 1.74-2.64]) and ICU length of stay (2.22 days [95% CI, 1.00-3.44]) but not mortality (risk ratio: 1.13 [95% CI, 0.98-1.31]; P = .09). Conclusions: Hypophosphatemia in ICU was associated with increased hospital and ICU length of stay but not all-cause mortality. Hypophosphatemia appears to be a marker of disease severity. Limited number of available studies and varied study designs did not allow for the ascertainment of the effect of severe hypophosphatemia on patient mortality.

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Section: Resultsmentioning

confidence: 99%

Hypophosphatemia and Outcomes in ICU: A Systematic Review and Meta-Analysis

Sin

King

Ballard

et al. 2020

J Intensive Care Med

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“…although not in all [26,27,[41][42][43][44]. In contrast, hypophosphatemia secondary to CRRT has limited clinical consequences in most retrospective studies [19,[45][46][47][48] (possibly related to "preventive" phosphate administration [49]), but not in all [34,48,50].…”

Section: Q1+2: Is Hypophosphatemia Associated With Development Of Organ Failures and Impaired Outcome In Adult Icu Patients?mentioning

confidence: 99%

Hypophosphatemia in critically ill adults and children – A systematic review

et al. 2021

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“…The model constructed by sPi levels, Hunt-Hess grade, and mFisher scale produced the best ability to predict aHCP compared with a single sPi level or mFisher scale, which was a valuable factor for predicting the occurrence of aHCP following aSAH. Previously reported literature demonstrated that aHCP and diffuse cerebral edema are more common in patients with non-traumatic intracranial hemorrhage accompanied by decreased sPi levels [17]. Based on it, we listed aSAH from non-traumatic ICH to explore the relationship between decrease sPi levels and aHCP.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, impressive literature reported that hypophosphatemia is associated with a disturbance of consciousness after spontaneous intracerebral hemorrhage (sICH), but its mechanism is still poorly understood [19]. Emerging literature indicated that hypophosphatemia is associated with HCP after sICH in the ICU [17]. However, the patients enrolled in this study were mixed with other causes of intracerebral hemorrhage, and the number of patients with ICH was small, so there was a particular research bias.…”

Section: Introductionmentioning

confidence: 97%

“…However, in acute disease, the body's phosphate metabolism cannot be regulated accurately [15]. Various studies have shown that sPi levels are closely related to the occurrence and prognosis of acute cerebrovascular disease [17][18][19][20]. Hypophosphatemia is a common treatable problem in the intensive care unit (ICU) and manifests many pathophysiological processes that occur in critical illness, including hemorrhagic stroke and other neurocritical diseases [21,22].…”

Section: Introductionmentioning

confidence: 99%

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Lower Serum Phosphate Ion Level is Associated with Acute Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage.

Kang

Zhang

Zheng

et al. 2021

Preprint

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Background: The relationship between serum phosphate ion (sPi) and the occurrence of acute hydrocephalus (aHCP) in aneurysmal subarachnoid hemorrhage (aSAH) remains largely unknown and controversial. The primary aim of this study was to evaluate the association between sPi on admission and aHCP following aSAH. Methods: A prospective study was conducted on six hundred thirty-five patients over the age of 19 years diagnosed with aSAH in our institution from January 21, 2012, to December 30, 2019. Data on clinical characteristics, laboratory parameters, treatments, and outcomes were collected and analyzed. The association between lower sPi levels and aHCP was assessed in univariate and multivariate analyses. Propensity-score matching (PSM) analyses were adopted to reduce the baseline differences between the non-HCP group and HCP group. Results: The overall incidence of aHCP following aSAH was 19.37% (123/512). Lower sPi levels were detected in patients with aHCP compared with those without [0.86(0.67-1.06) mmol/L vs. 1.04(0.84-1.21)] mmol/L in the univariate analysis. In the multivariate analysis, lower sPi, high modified Fisher (mFisher) grade, and high Hunt-Hess grade were associated with aHCP [odds ratios (OR) 1.729, 95% CI 1.139–2.623, P=0.01; mFisher OR 0.097,95%CI 0.055-0.172, p<0.001; Hunt-Hess, OR 0.555, 95% confidence interval (CI) 0.320–0.961, P=0.036]. After PSM, the matched HCP group had a significantly lower sPi level than the matched non-hydrocephalus group [(0.86(0.67-1.06) vs. 0.94(0.76-1.12) mmol/L, P= 0.020)]. The area under the curve (AUC) of the sPi level and the logistic regression model based on these predictors (sPi, Hunt-Hess grade, and mFisher score) was 0.667 and 0.840 (sensitivity of 88.6% and specificity of 68.4%) for predicting aHCP, respectively. Conclusion: Lower sPi levels at admission were observed in patients with unfavorable outcomes. Lower sPi levels were associated with aHCP and poor prognosis, and the model constructed by sPi levels, Hunt-Hess grade, and mFisher grade significantly improves the prediction of aHCP after aSAH.

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Hypophosphatemia after nontraumatic intracranial hemorrhage

Abstract: Hypophosphatemia was common in this patient population. The outcome was similar between hypophosphatemic and normophosphatemic patients. Chronic hypertension, acute hydrocephalus, diffuse brain edema and higher SOFA scores were more common in patients with hypophosphatemia.

Cited by 15 publications

References 30 publications

Hypophosphatemia and Outcomes in ICU: A Systematic Review and Meta-Analysis

Hypophosphatemia and Outcomes in ICU: A Systematic Review and Meta-Analysis

Hypophosphatemia in critically ill adults and children – A systematic review

Lower Serum Phosphate Ion Level is Associated with Acute Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage.

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