Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

Cheungpasitporn, Wisit; Hansrivijit, Panupong; Medaura, Juan; Chewcharat, Api; Mao, Michael A; Vallabhajosyula, Saraschandra; Thirunavukkarasu, Sorkko; Erickson, Stephen B.

doi:10.3390/medicina56030106

Cited by 11 publications

(8 citation statements)

References 52 publications

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“…In-hospital hypocalcemia and hypercalcemia were significantly associated with higher in-hospital mortality compared with persistently normal serum ionized calcium levels throughout hospitalization. This finding is in line that in-hospital mortality progressively increased with greater total calcium level changes, either in a decremental or incremental direction [ 12 ]. Our studies support the significance of calcium level fluctuations toward mortality.…”

Section: Discussionsupporting

confidence: 82%

“…Disturbances of serum calcium, hypocalcemia and hypercalcemia, are associated with increased mortality [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. A large retrospective cohort study of the United States Department of Veterans Affairs involving 1.9 million patients suggested a U-shaped association between calcium disturbances and mortality [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Hospital-Acquired Serum Ionized Calcium Derangements and Their Associations with In-Hospital Mortality

et al. 2020

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Background: The objective of this study was to report the incidence of in-hospital serum ionized calcium derangement and its impact on mortality. Methods: We included 12,599 non-dialytic adult patients hospitalized at a tertiary medical center from January 2009 to December 2013 with normal serum ionized calcium at admission and at least 2 in-hospital serum ionized calcium values. Using serum ionized calcium of 4.60–5.40 mg/dL as the normal reference range, in-hospital serum ionized calcium levels were categorized based on the presence of hypocalcemia and hypercalcemia in hospital. We performed logistic regression to assess the relationship of in-hospital serum ionized calcium derangement with mortality. Results: Fifty-four percent of patients developed new serum ionized calcium derangements: 42% had in-hospital hypocalcemia only, 4% had in-hospital hypercalcemia only, and 8% had both in-hospital hypocalcemia and hypercalcemia. In-hospital hypocalcemia only (OR 1.28; 95% CI 1.01–1.64), in-hospital hypercalcemia only (OR 1.64; 95% CI 1.02–2.68), and both in-hospital hypocalcemia and hypercalcemia (OR 1.73; 95% CI 1.14–2.62) were all significantly associated with increased in-hospital mortality, compared with persistently normal serum ionized calcium levels. Conclusions: In-hospital serum ionized calcium derangements affect more than half of hospitalized patients and are associated with increased in-hospital mortality.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Hospital-Acquired Serum Ionized Calcium Derangements and Their Associations with In-Hospital Mortality

et al. 2020

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“…Clinical characteristics included age, sex, race, principal diagnoses, comorbidities, estimated glomerular filtration rate (eGFR), acute kidney injury (AKI), the number of in-hospital serum phosphate measurements, and the length of hospital stay. The data collection of these clinical characteristics was described in our previous studies [20][21][22].…”

Section: Data Collectionmentioning

confidence: 99%

Impact of serum phosphate changes on in-hospital mortality

et al. 2020

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Background Fluctuations in serum phosphate levels increased mortality in end-stage renal disease patients. However, the impacts of serum phosphate changes in hospitalized patients remain unclear. This study aimed to test the hypothesis that serum phosphate changes during hospitalization were associated with in-hospital mortality. Methods We included all adult hospitalized patients from January 2009 to December 2013 that had at least two serum phosphate measurements during their hospitalization. We categorized in-hospital serum phosphate changes, defined as the absolute difference between the maximum and minimum serum phosphate, into 5 groups: 0–0.6, 0.7–1.3, 1.4–2.0, 2.1–2.7, ≥2.8 mg/dL. Using serum phosphate change group of 0–0.6 mg/dL as the reference group, the adjusted odds ratio of in-hospital mortality for various serum phosphate change groups was obtained by multivariable logistic regression analysis. Results A total of 28,149 patients were studied. The in-hospital mortality in patients with serum phosphate changes of 0–0.6, 0.7–1.3, 1.4–2.0, 2.1–2.7, ≥2.8 mg/dL was 1.5, 2.0, 3.1, 4.4, and 10.7%, respectively (p < 0.001). When adjusted for confounding factors, larger serum phosphate changes were associated with progressively increased in-hospital mortality with odds ratios of 1.35 (95% 1.04–1.74) in 0.7–1.3 mg/dL, 1.98 (95% CI 1.53–2.55) in 1.4–2.0 mg/dL, 2.68 (95% CI 2.07–3.48) in 2.1–2.7 mg/dL, and 5.04 (95% CI 3.94–6.45) in ≥2.8 mg/dL compared to serum phosphate change group of 0–0.6 mg/dL. A similar result was noted when we further adjusted for either the admission or mean serum phosphate during hospitalization. Conclusion Greater serum phosphate changes were progressively associated with increased in-hospital mortality.

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“…We used the RCS model to fit a cut-off value of serum calcium = 8.5 mg/dl for grouping and could find that patients with serum calcium <8.5 mg/dl had a significantly increased risk of prolonged LOS and in-hospital mortality. In recent years, a growing number of studies have found that serum calcium levels affect the LOS and all-cause mortality in hospitalized patients [ 11 , 12 , 22 ]. With the recent introduction of the concept of promoting recovery after surgery (ERAS) in the management of surgical diseases, it is generally accepted that, except for albumin or body mass index, calcium or phosphorus may also be important indicators for assessing the nutritional status of surgical patients [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Admission Serum Calcium Levels and Length of Stay in Patients with Acute Pancreatitis: Data from the MIMIC-III Database

Wang

Guo

Xia

et al. 2022

Emergency Medicine International

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Objective. We retrospectively investigated the effect of admission serum calcium levels on length of stay (LOS) in patients hospitalized with acute pancreatitis (AP). Methods. Clinical data for 3156 patients diagnosed with AP were obtained from the Multiparametric Intelligent Monitoring in Intensive Care III (MIMIC-III) database. Restricted cubic spline curve (RCS) functions of dose-response analysis curves and logistic regression analysis were used to analyze the relationship between admission serum calcium levels and the LOS. Results. All patients were divided into 2 groups (<8.5 mg/dl group and ≥8.5 mg/dl group) based on RCS analysis. RCS showed a significant nonlinear negative correlation between blood calcium levels and the LOS ( p < 0.001 ). In addition, compared with patients with blood calcium <8.5 mg/dl, multivariate logistic regression analysis showed that patients with blood calcium ≥8.5 mg/dl had a reduced risk of the LOS >2 days (aOR = 0.653; 95% CI 0.507–0.842; p = 0.001 ), a reduced risk of the LOS >5 days (aOR = 0.589; 95% CI 0.503–0.689; p < 0.001 ), and a reduced risk of the LOS >7 days (aOR = 0.515; 95% CI 0.437–0.609; p < 0.001 ). And similar results were found in the subgroup analysis. Conclusion. Our findings suggest that low blood calcium increases the LOS in patients with AP. More attention is needed for patients with combined low blood calcium levels (<8.5 mg/dl) in hospitalized AP patients.

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Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

Cited by 11 publications

References 52 publications

Hospital-Acquired Serum Ionized Calcium Derangements and Their Associations with In-Hospital Mortality

Hospital-Acquired Serum Ionized Calcium Derangements and Their Associations with In-Hospital Mortality

Impact of serum phosphate changes on in-hospital mortality

Effect of Admission Serum Calcium Levels and Length of Stay in Patients with Acute Pancreatitis: Data from the MIMIC-III Database

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