Abstract

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.

Highlights

  • Electrolyte disturbances, such as dysnatremia, hypokalemia, and hypomagnesemia, are frequently observed during acute spontaneous subarachnoid hemorrhage

  • Since hypophosphatemia may be associated with poor neurological outcomes, patients with spontaneous subarachnoid hemorrhage (sSAH) need cautious phosphate repletion

  • During the two-year study period, 83 patients with sSAH were treated in the Neuro-intensive care unit (ICU), and 92 nonneurocritical patients admitted to the same ICU department were evaluated (Figure 1)

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Summary

Introduction

Electrolyte disturbances, such as dysnatremia, hypokalemia, and hypomagnesemia, are frequently observed during acute spontaneous subarachnoid hemorrhage (sSAH). Spontaneous subarachnoid hemorrhage (sSAH) can occur because of the rupture of an aneurysm or arteriovenous malformation, hypertension, or an unknown cause [1]. In Europe, approximately 36,000 new cases of subarachnoid hemorrhage (SAH) occur per year. Radiological, and medical treatment, the rupture of an aneurysm is still associated with a high incidence of mortality and severe long-term disability [2]. Outcomes after SAH depend mainly on the initial severity of the hemorrhage. Electrolyte disturbances are common in patients in the intensive care unit (ICU). Dysnatremia, hypomagnesia, and hypokalemia frequently occur in the acute period after SAH, but studies on electrolyte disturbances in SAH have controversial results [3,5]

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