ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurotrauma
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1474809
The U-shaped association between initial serum phosphate level and mortality of traumatic brain injury patients
Provisionally accepted
- West China Hospital, Sichuan University, Chengdu, China
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Background: Phosphate disorders including hypophosphatemia and hyperphosphatemia influence the prognosis of patients. We design this study to explore the relationship between serum phosphate level and mortality of TBI.Methods: TBI patients from the Medical Information Mart for Intensive Care-III (MIMIC-III) database were included in this study. Univariate logistic regression was conducted to discover potential risk factors for mortality of TBI. The restricted cubic spline (RCS) was conducted to explore the non-linear relationship between serum phosphate level and mortality of TBI both before and after adjusting risk factors discovered in the univariate logistic regression. Length of ICU stay, length of hospital stay, and 30-day mortality were compared between groups of different serum phosphate levels.Results: 400 TBI patients suffered death with a mortality rate of 17.6%. Utilizing the RCS, the unadjusted and adjusted association between serum phosphate level and the mortality of TBI both were shown as U-shaped curve. We divided the serum phosphate level into three groups: <3.0 mg/dL, 3.0-4.0 mg/dL, >4.0 mg/dL according to the U-shaped curve.Multivariate logistic regression confirmed that <3.0 mg/dL (p=0.012) and >4.0 mg/dL (p=0.024) were associated with a higher risk of mortality than 3.0-4.0 mg/dL. The mortality of these three groups was 19.1%, 14.4%, and 23.4%, respectively (p<0.001). The Kaplan-Meier analysis showed a significant difference in survival between the three groups (p<0.001).Conclusion： Both higher and lower serum phosphate level is associated with the mortality of TBI patients. Evaluating serum phosphate levels is beneficial to identify TBI patients with high risks of poor prognosis.
Keywords: Phosphate, Hyperphosphatemia, Hypophosphatemia, Traumatic Brain Injury, Mortality
Received: 02 Aug 2024; Accepted: 19 May 2025.
Copyright: © 2025 Wang, Yang, Xu and He. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Min He, West China Hospital, Sichuan University, Chengdu, China
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