Wang Ruoran, Zhang Jing, Xu Jianguo, He Min
Department of Neurosurgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, Sichuan Province, 610041, China.
Department of Critical Care Medicine, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, Sichuan Province, 610041, China.
Neurosurg Rev. 2024 Dec 7;47(1):891. doi: 10.1007/s10143-024-03129-x.
Disorders of serum phosphate, including hyperphosphatemia and hypophosphatemia, have been confirmed to be related to the poor prognosis of specific critically ill patients. No study analyzes the relationship between continuous serum phosphate level and mortality from aneurysmal subarachnoid hemorrhage (aSAH). This study was performed to explore this relationship. aSAH patients were divided into four groups based on serum phosphate quartiles. Significant factors discovered in the univariate Cox regression were included in the multivariate Cox regression to explore the independent relationship between serum phosphate and mortality of aSAH. Kaplan-Meier survival analysis was performed to compare the difference in survival between the four groups. The 60-day mortality of overall aSAH patients was 20.7%. The mortality of the group with the 1st quartile (29.4%) and the 4th quartile (24.7%) had higher mortality than others (p = 0.028). Univariate Cox regression showed the 2nd quartile (p = 0.020) and 3rd quartile (p = 0.017) were associated with lower mortality risk than the 1st quartile. Compared with the 1st quartile, the 4th quartile was not associated with lower mortality risk (p = 0.458). After adjusting confounding effects, multivariate Cox regression showed only the 4th quartile was significantly associated with higher mortality risk (p = 0.009) than the 1st quartile. The unadjusted relationship between serum phosphate and mortality of aSAH is U-shaped. While high serum phosphate even within the normal range is independently related to the mortality of aSAH. Low serum phosphate may be just a marker for the severity of aSAH. Evaluating the initial serum phosphate is useful for risk stratification of aSAH.
血清磷酸盐紊乱，包括高磷血症和低磷血症，已被证实与特定重症患者的不良预后相关。尚无研究分析血清磷酸盐持续水平与动脉瘤性蛛网膜下腔出血（aSAH）患者死亡率之间的关系。本研究旨在探讨这种关系。根据血清磷酸盐四分位数将aSAH患者分为四组。单因素Cox回归中发现的显著因素纳入多因素Cox回归，以探讨血清磷酸盐与aSAH患者死亡率之间的独立关系。采用Kaplan-Meier生存分析比较四组患者的生存差异。总体aSAH患者的60天死亡率为20.7%。第一四分位数组（29.4%）和第四四分位数组（24.7%）的死亡率高于其他组（p = 0.028）。单因素Cox回归显示，与第一四分位数相比，第二四分位数（p = 0.020）和第三四分位数（p = 0.017）的死亡风险较低。与第一四分位数相比，第四四分位数与较低的死亡风险无关（p = 0.458）。在调整混杂效应后，多因素Cox回归显示，仅第四四分位数与高于第一四分位数的死亡风险显著相关（p = 0.009）。血清磷酸盐与aSAH死亡率之间的未调整关系呈U形。即使在正常范围内，高血清磷酸盐也与aSAH死亡率独立相关。低血清磷酸盐可能只是aSAH严重程度的一个指标。评估初始血清磷酸盐对aSAH的风险分层有用。
