Abstract
Introduction: 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 investigate the association between sPi on admission and aHCP following aSAH.Methods: The study included 635 patients over the age of 19 years diagnosed with aSAH in our institution from September 2012 to June 2018. 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) analysis was performed to reduce significant differences in baseline characteristics between the aHCP group and non-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) vs. 1.04 (0.84–1.21) mmol/L] in the univariate analysis. In the multivariate analysis, lower sPi level, high modified Fisher (mFisher) grade, and high Hunt-Hess grade were associated with aHCP [odds ratios (OR) 1.729, 95% confidence interval (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% CI 0.320–0.961, P = 0.036]. After PSM, the matched aHCP group had a significantly lower sPi level than the matched non-aHCP group [0.86 (0.67–1.06) vs. 0.94 (0.76–1.12) mmol/L, p = 0.044]. 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 grade) was 0.667 and 0.840 (sensitivity of 88.6% and specificity of 68.4%) for predicting aHCP, respectively.Conclusions: Lower sPi levels predict the occurrence of aHCP, and the model constructed by sPi levels, Hunt-Hess grade, and mFisher grade markedly enhances the prediction of aHCP after aSAH.
Highlights
The relationship between serum phosphate ion and the occurrence of acute hydrocephalus in aneurysmal subarachnoid hemorrhage remains largely unknown and controversial
Patients were included in the analysis with the following inclusion criteria: [1] age ≥19 years old; [2] Computed tomography (CT) scans confirmed the diagnosis of SAH on admission; [3] Computed tomography angiography (CTA) and/or digital subtraction angiography (DSA) diagnosed subarachnoid hemorrhage due to a ruptured cerebral aneurysm; [4] survival for no
The AUC of the logistic regression model based on these predictors was 0.840 with a sensitivity of 88.6% and specificity of 68.4% for acute hydrocephalus (aHCP), which is a stronger aHCP predictor than a single serum phosphate ion (sPi) level (AUC: 0.667) (Figure 2C)
Summary
The relationship between serum phosphate ion (sPi) and the occurrence of acute hydrocephalus (aHCP) in aneurysmal subarachnoid hemorrhage (aSAH) remains largely unknown and controversial. Numerous factors, including female sex, elderly age, higher mFisher grade, intraventricular hemorrhage, and laboratory findings, have been reported in prior literature to predict the occurrence of aHCP following aSAH [1, 7, 8, 10, 11]. Considerable efforts have been focused on studying sensitive biomarkers for predicting aHCP [12,13,14], but reports of these biomarkers on the risk factors for aHCP development are inconsistent and controversial [13,14,15,16]. It is necessary to explore inexpensive and convenient biomarkers to provide valuable information for appropriate clinical treatment in patients with aSAH and prediction of HCP or prognosis
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