SIGNIFICANCE OF INITIAL SERUM PHOSPHATE IMBALANCE IN TRAUMATIC BRAIN INJURY: RETROSPECTIVE ANALYSIS aymanco65@yahoo.com

 

SIGNIFICANCE OF INITIAL SERUM PHOSPHATE IMBALANCE IN TRAUMATIC BRAIN INJURY: RETROSPECTIVE ANALYSIS

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Electrolyte imbalance is common following traumatic injuries and poses a substantial impact on the hospital course. However, early phosphate imbalance in traumatic brain injury (TBI) is scarce in the literature and even fewer in patients with spinal injuries. This study aimed to assess the significance of on-admission phosphate imbalance (OAPI) in TBI patients, including those who had concomitant spinal injuries (CSI).

This is a retrospective analysis of all the hospitalized patients who had TBI, and their serum phosphate levels were measured on admission. Data including injury severity, electrolyte levels, spinal injuries, and in-hospital mortality were analysed.

There were 912 TBI patients, 13% of them had hyperphosphatemia, and 30% (N=272) had associated spinal injuries (CSI). Hypophosphatemia was found in two-thirds of TBI patients regardless of the spinal injuries. Thirteen patients in the CSI group developed neurological deficits, and all of them had hypophosphatemia. Serum phosphate levels were significantly correlated with serum potassium, magnesium, and lactate levels, as well as ISS in the TBI cohort. The serum glucose-phosphate ratio was higher in patients with severe GCS. The overall mortality was 21.3% (47% of them had hyperphosphatemia). Multivariable analysis showed that hyperphosphatemia, high serum lactate, sodium, and potassium levels, high head AIS, and low GCS were significantly associated with increased mortality.

Hypophosphatemia is common in TBI patients regardless of the spinal injuries and is observed in all patients with neurological deficits. Routine phosphate monitoring may help in early risk stratification and targeted management in TBI patients with and without spinal injury.