Serum Calcium as Prognosticator in Ischemic Stroke

Abstract

on behalf of the VISTA Investigators Background and Purpose-Calcium (Ca 2ϩ ) plays a role in the cellular and molecular pathways of ischemic neuronal death. We evaluated the impact of both early and delayed Ca 2ϩ levels on clinical outcomes from acute ischemic stroke. Methods-The relations between blood calcium level obtained early (Ͻ4.5 hours), and delayed (72 to 96 hours) after ischemic stroke onset versus clinical outcomes were analyzed in 826 subjects enrolled in an international trial in the Virtual International Stroke Trials Archive. Subjects were categorized into Ca 2ϩ quartiles. Outcome measures analyzed included baseline and 72-to 96-hour stroke severity, as well as 3-month functional and global disability scales. The independent effect of calcium on outcome was evaluated by median and logistic regression analysis. Results-Six hundred and fifty-nine (80%) of the trial subjects had complete baseline data including Ca 2ϩ levels. Bivariately, the highest delayed Ca 2ϩ quartile (versus lowest) was associated with lesser stroke severity and better 3-month functional and independence scale outcomes (all PϽ0.001), but no significant outcome differences were noted among early Ca 2ϩ levels. In multivariable analysis, delayed Ca 2ϩ in the highest quartile (versus lowest quartile) was associated with greater 3-month independence score on the Barthel Index scale (76.9 versus 55.4, Pϭ0.006). No other significant outcome differences were noted between highest and lowest quartiles for both early and delayed Ca

Low Serum Calcium Levels Contribute to Larger Hematoma Volume in Acute Intracerebral Hemorrhage

“…2,3 Several studies have reported that low serum calcium (Ca) levels have an association with large infarcts and poor outcome among patients with ischemic stroke. [4][5][6] In another study involving a majority of patients with ischemic stroke and few patients with ICH, low serum Ca levels were also associated with poor outcome. 7 In addition, ionized Ca is an essential cofactor for the coagulation cascade and associated with conversion of prothrombin to thrombin.…”

Prognostic Significance of Serum Calcium Level in a Sample of Egyptian Patients With Intracerebral Hemorrhage.

“…It was observed that poor outcome in patients with ischemic stroke was related to lower serum calcium on admission 6,8,26 . Moreover, previously D' Erasmo and colleagues 27 recorded that low serum Ca was associated with in-hospital mortality among ischemic stroke patients.…”

“…Serum calcium (Ca) is an essential factor for human life, it plays a role in the pathophysiology of cerebral ischemia and influences the molecular pathways of ischaemic neuronal death [6][7] . Previous researchers [6][7][8] had reported an association between serum Ca level and ischemic strokes as it was observed that a high serum Ca level was associated with a small infract size and less severe ischemic stroke 7 .…”

“…Previous researchers [6][7][8] had reported an association between serum Ca level and ischemic strokes as it was observed that a high serum Ca level was associated with a small infract size and less severe ischemic stroke 7 . In addition, Appel et al, 9 observed that ischemic stroke patients with high ca level had a favorable outcome in comparison to those with low Ca level.…”

Prognostic Factors of Stroke: the review of factors related to patient

“…Bruce Ovbiagele ve ark. (76), serum kalsiyumunun stroktan sonra 72 ve 96. saatlerdeki değerinin, 3 aylık fonksiyonel kapasiteyi gösterebilen bir değer olduğunu öne sürmüşlerdir. Ancak, erken kalsiyum değerinin ise prognostik değeri olmadığı daha çok mortal seyrettiğini gözlemişlerdir.…”