Association of Serum Calcium Levels with Infarct Size in Acute Ischemic Stroke: Observations from Northeast India

Abstract

Background:Calcium is known to be major mediator in ischemic neuronal cell death. Recent studies have shown that elevated serum calcium levels at admission in patients with stroke have been associated with less severe clinical deficits and with better outcomes.Aim:The aim of this to determine the correlation between serum calcium (total, corrected, and ionized) and infarct size (IS) in patients with acute ischemic stroke.Materials and Methods:Data were collected from 61 patients presenting with acute ischemic stroke from May 2015 to April 2016 at a tertiary care institute in Northeast India. Only patients aged ≥40 years and diagnosed as having acute ischemic cerebrovascular stroke with clinical examination and confirmed by a computed tomography scan were included in the study. Serum calcium levels (total, albumin corrected, and ionized) were collapsed into quartiles, and these quartile versions were used for calculating correlation. Pearson's correlation coefficient was used for comparing calcium levels with IS.Results:Total calcium, albumin-corrected calcium, and ionized calcium had a statistically significant negative correlation with IS with r = −0.578, −0.5396, and −0.5335, respectively. Total and ionized calcium showed a significant negative correlation with IS across all four quartiles. Albumin-corrected calcium levels showed a significant negative correlation with IS only across the lowest and highest quartiles.Conclusion:The findings in our study suggest that serum calcium can be used as a prognostic indicator in ischemic stroke as its levels directly correlates with the IS.

Phosphodiesterase-5 Inhibitor Attenuates Anxious Phenotypes and Movement Disorder Induced by Mild Ischemic Stroke in Rats

“…Ca 2+ ions play a vital role as a major initiator and activator in the ischemic cell death pathways [ 15 ]. Elevated levels of intracellular Ca 2+ ions in serum plays a role in decrease of infarct volume and outcome in ischemic stroke patients [ 11 , 12 , 48 ]. Ca 2+ accumulation triggers mitochondrial damage and contributes to delayed neuronal death as well as ROS [ 15 , 40 ].…”

Association of serum calcium levels with clinical severity of ischemic stroke at the time of admission as defined by NIHSS score: A cross-sectional, observational study

“…Another Indian study by Borah M, et al . [ 13 ] found that a negative correlation was found between serum calcium levels and infarct size in acute ischemic stroke. In contrast, one study by Chung JW, et al .…”

The association of admission ionized calcium with outcomes of thrombolysed patients with anterior circulation ischemic stroke

“…In agreement with our study, one study reported that total serum Ca 2+ levels in the early stages of AIS (< 4.5 h) was not associated with long‐term outcome (Ovbiagele et al., 2008 ). However, some studies reported their relationship: (1) low level of serum calcium was obviously associated with poor outcome (Chung et al., 2015 ; D'Erasmo et al., 1998 ) and more severe neurological deficit (Guven et al., 2011 ; Ishfaq et al., 2017 ; Ovbiagele et al., 2006 ), and bigger infarction volume (Borah et al., 2016 ; Buck et al., 2007 ) of ischemic stroke patients; (2) high levels of albumin‐corrected calcium, but not serum calcium are associated with a poor discharge outcome and a higher incidence of mortality after AIS (Chung et al., 2015 ); (3) an increased risk of poor functional outcome was found in the third quartile group and an increased risk of all‐cause mortality in the top quartile group of serum albumin corrected calcium levels within 24 h of hospital admission in patients with AIS and transient ischemic attack (Zhang et al., 2021 ).…”