Prognostic value of serum phosphate level in elderly post-cardiac arrest patients
1Department of Emergency Medicine, Seoul National University Bundang Hospital, 13620 Seongnam-si, Republic of Korea
2Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, 18450 Hwaseong, Republic of Korea
3Department of Emergency Medicine, Seoul National University College of Medicine, 03080 Seoul, Republic of Korea
4Department of Emergency Medicine, Seoul Metropolitan Government—Seoul National University Boramae Medical Center, 07061 Seoul, Republic of Korea
5Division of Critical Care Medicine, Seoul National University Hospital, 03080 Seoul, Republic of Korea
6Department of Emergency Medicine, Uijeongbu Eulji Medical Center, Eulji University, 11759 Uijeongbu, Republic of Korea
Submitted: 17 February 2022 Accepted: 07 May 2022
Online publish date: 06 July 2022
† These authors contributed equally.
Prognosticating the neurological outcomes of cardiac arrest is important. A recent study has shown that serum phosphate (SP) may be a prognostic indicator for poor neurological outcomes in cardiac arrest patients. Due to advancements in medicine, more elderly patients survive cardiac arrest than ever before, and prognostication of the markers in this population has not been studied previously. We aimed to confirm the hypothesis that a higher SP level predicts a poor neurological outcome of cardiac arrest, even in elderly patients. This retrospective observational study included post-cardiac arrest elderly patients (aged ≥ 65 years) who were admitted to three hospitals in urban areas in South Korea from December 2013 to February 2020. Data regarding patient characteristics, laboratory values, and neurological outcomes at 28 days were collected from patients’ medical records. The primary outcome was poor neurological outcome (Cerebral Performance Category scores 3–5) at 28 days. Of the 389 eligible patients, 334/389 had poor neurological outcomes at 28 days. SP levels were significantly higher in those with poor neurological outcomes than in those with good neurological outcomes (7.32 vs. 5.01, p < 0.001). Multivariate logistic regression analysis also showed that SP levels were independently associated with neurological outcomes. Receiver operating characteristic curve analysis of SP levels showed an area under the curve of 0.772. Higher SP levels are associated with poor neurological outcomes after cardiac arrest in the elderly population.
Heart arrest; Prognosis; Phosphates; Aged
Hee Eun Kim,Young Taeck Oh,You Hwan Jo,Jonghwan Shin,Seung Min Park,Dong Keon Lee,Yoon Sun Jung,Dong-Hyun Jang,on behalf of the SNU CARE Investigators. Prognostic value of serum phosphate level in elderly post-cardiac arrest patients. Signa Vitae. 2022.doi:10.22514/sv.2022.047.
 Libungan B, Lindqvist J, Strömsöe A, Nordberg P, Hollenberg J, Albertsson P, et al. Out-of-hospital cardiac arrest in the elderly: a large-scale population-based study. Resuscitation. 2015; 94: 28–32.
 Sandroni C, D’Arrigo S, Cacciola S, Hoedemaekers CWE, Kamps MJA, Oddo M, et al. Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review. Intensive Care Medicine. 2020; 46: 1803–1851.
 Dundar ZD, Cander B, Gul M, Karabulut KU, Kocak S, Girisgin S, et al. Serum intestinal fatty acid binding protein and phosphate levels in the diagnosis of acute intestinal ischemia: an experimental study in rabbits. The Journal of Emergency Medicine. 2012; 42: 741–747.
 Itoh K, Matsubaba T, Nanki M, Nishimura K, Kmabe T, Sugiyama S, et al. Relationship between regional myocardial blood flow and high energy phosphate (ATP) in acute ischemia. Journal of Molecular and Cellular Cardiology. 1981; 13: 58.
 Neumar RW, Brown CG, Van Ligten P, Hoekstra J, Altschuld RA, Baker P. Estimation of myocardial ischemic injury during ventricular fibrillation with total circulatory arrest using high-energy phosphates and lactate as metabolic markers. Annals of Emergency Medicine. 1991; 20: 222–229.
 Kintu-Luwaga R, Galukande M, Owori FN. Serum lactate and phosphate as biomarkers of intestinal ischemia in a Ugandan tertiary hospital: a cross-sectional study. International Journal of Emergency Medicine. 2013; 6: 44.
 Zettervall SL, Soden PA, Ultee KHJ, Seldon C, Oh J, McGann K, et al. Elevated serum phosphate levels are associated with decreased amputation-free survival after interventions for critical limb ischemia. Journal of Vascular Surgery. 2017; 65: 431–437.
 Jung YH, Lee BK, Jeung KW, Youn CS, Lee DH, Lee SM, et al. Prognostic value of serum phosphate level in adult patients resuscitated from cardiac arrest. Resuscitation. 2018; 128: 56–62.
 Ye X, Kooman JP, van der Sande FM, Raimann JG, Usvyat LA, Wang Y, et al. Relationship between serum phosphate levels and survival in chronic hemodialysis patients: interactions with age, malnutrition and inflammation. Clinical Kidney Journal. 2021; 14: 348–357.
 Chen Y, Luo M, Xu H, Zhao W, He Q. Association between serum phosphate and mortality in critically ill patients: a large retrospective cohort study. BMJ Open. 2021; 11: e044473.
 Broman M, Wilsson AMJ, Hansson F, Klarin B. Analysis of hypo-and hyperphosphatemia in an intensive care unit cohort. Anesthesia & Analgesia. 2017; 124: 1897–1905.
 Barreto FC, Barreto DV, Massy ZA, Drüeke TB. Strategies for phosphate control in patients with CKD. Kidney International Reports. 2019; 4: 1043–1056.
 Xu H, Evans M, Gasparini A, Szummer K, Spaak J, Ärnlöv J, et al. Outcomes associated to serum phosphate levels in patients with suspected acute coronary syndrome. International Journal of Cardiology. 2017; 245: 20–26.
 Lederer E. Regulation of serum phosphate. The Journal of Physiology. 2014; 592: 3985–3995.
 Kestenbaum B, Sampson JN, Rudser KD, Patterson DJ, Seliger SL, Young B, et al. Serum phosphate levels and mortality risk among people with chronic kidney disease. Journal of the American Society of Nephrology. 2005; 16: 520–528.
 Dhingra R, Sullivan LM, Fox CS, Wang TJ, D’Agostino RB Sr, Gaziano JM, et al. Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community. Archives of Internal Medicine. 2007; 167: 879–885.
 Schoerkhuber W, Kittler H, Sterz F, Behringer W, Holzer M, Frossard M, et al. Time course of serum neuron-specific enolase: a predictor of neurological outcome in patients resuscitated from cardiac arrest. Stroke. 1999; 30: 1598–1603.
 Lee YJ, Kim W, Kang GH, Jang YS, Choi HY, Kim YY, et al. Analysis of prognostic factors for return of spontaneous circulation and survival in elderly patients with cardiac arrest. Journal of the Korean Geriatrics Society. 2015; 19: 218–225.
 Qiu S, Zheng G, Chen B, Huang J, Shen J, Mao W. Prognostic value of admission serum glucose-phosphate ratio in predicting the 6-month outcome of patients with severe traumatic brain injury: a retrospective study. Clinica Chimica Acta. 2020; 510: 659–664.
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