The Prognostic Value of Calcium in Post-Cardiovascular Surgery Patients in the Intensive Care Unit

Abstract

Background: Present researches exploring the prognostic value of calcium concentration are undermined by sample size and study design. Our study investigated the association of both total calcium (tCa) and ionized Ca (iCa) to short- and long-term mortality and other outcomes in post-cardiovascular surgery (PCS) patients admitted to intensive care unit (ICU) from two large public data sets.Methods: The Medical Information Mart for Intensive Care III (MIMIC-III) database and the eICU Collaborative Research Database (eICU) were inspected to identify PCS patients. The primary outcome was 28-day mortality. Multivariate regression was used to elucidate the relationship between calcium concentration and outcomes. The propensity score estimation was performed to validate our findings.Results: A total of 6122 and 914 patients were included from the MIMIC III and eICU data sets, respectively. The groups with the most patients were the mild hypo-iCa and hypo-tCa groups. The mild hypo-iCa group showed significant association with worse short-term and long-term prognosis, less use of ventilation, longer ICU and hospital stay, and more incidence of 7-day acute kidney injury.Conclusions: The mild hypo-iCa (0.9–1.15 mmol/L) within the first day of admission to the ICU could serve as an independent prognosis factor for PCS patients.

Analysis of serum calcium change trajectories and prognostic factors in patients with acute type A aortic dissection

“…Thus, patients with lower serum calcium levels were more likely to require PMV. Bi et al [ 24 ] conducted a logistic multiple regression analysis of the risk factors of AKI in patients in the ICU after cardiac surgery, showing that hypocalcemia during an ICU stay is a high-risk factor for AKI, consistent with the results of the current study. When hemodynamic instability occurs, renal perfusion decreases.…”

Development and Validation of a Personalized Model With Transfer Learning for Acute Kidney Injury Risk Estimation Using Electronic Health Records

“…We explored interactions between medications and diagnoses within the personalized model with transfer learning (eAppendix 7, eTables 16 and 17 in the Supplement ). Some interactions identified were supported by previous evidence, such as an important outcome of serum calcium level specific to patients who had cardiac surgery, mechanical ventilation, and burns 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 or an interaction of both gastrointestinal surgery and tazobactam with vancomycin. 77 , 78 …”

Investigating Potential Correlations between Calcium Metabolism Biomarkers and Periprocedural Clinical Events in Major Cardiovascular Surgeries: An Exploratory Study

“…While this theory is not novel [18], there is a shortage of large cohort studies in this field, with studies focusing on the correlation of calcium levels predominantly carried out within populations with ACS [19][20][21]. The most important study comes from China, from Bi et al who studied over 6000 patients and found a significant association between worse short-term and long-term prognosis, less use of ventilation, longer ICU and hospital stays, and a higher incidence of 7-day acute kidney injury in the mild hypo-ionized calcium group (0.9-1.15 mmol/L) [22]. The authors concluded that hypocalcemia within the first day of admission to the ICU could serve as an independent prognosis factor for post-cardiovascular surgical patients [22].…”

“…The most important study comes from China, from Bi et al who studied over 6000 patients and found a significant association between worse short-term and long-term prognosis, less use of ventilation, longer ICU and hospital stays, and a higher incidence of 7-day acute kidney injury in the mild hypo-ionized calcium group (0.9-1.15 mmol/L) [22]. The authors concluded that hypocalcemia within the first day of admission to the ICU could serve as an independent prognosis factor for post-cardiovascular surgical patients [22]. Our data align with the findings of this specific study, thereby enhancing the concept of identifying and correcting calcium levels before surgery.…”