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Serum calcium levels and long-term mortality in patients with acute stroke
Shmuel A Appel1, Noa Molshatzki, Yvonne Schwammenthal
1Stroke Center, Department of Neurology, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
Insights
Serum calcium levels impact stroke patient survival. Both low and high levels, particularly in women, are linked to increased mortality risk, suggesting an optimal range for better outcomes.
Area of Science:
- Neurology
- Endocrinology
- Clinical Chemistry
Background:
- Serum calcium homeostasis is tightly regulated within a narrow physiological range.
- Abnormal serum calcium levels may influence various health outcomes, including neurological events.
- The association between serum calcium and stroke prognosis requires further investigation.
Purpose of the Study:
- To investigate the relationship between serum calcium and albumin-adjusted calcium levels and stroke outcomes.
- To determine if these associations differ based on calcium levels (low, normal, high) and patient sex.
- To explore linear and non-linear associations between calcium levels and mortality after acute stroke.
Main Methods:
- A cohort of 784 unselected acute stroke patients (ischemic or intracerebral hemorrhage) was followed for 1 year.
- Baseline total serum calcium and albumin-adjusted calcium levels were categorized as low (<8.6 mg/dl), normal (8.7-9.9 mg/dl), or high (>10 mg/dl).
- Statistical models examined linear and quadratic relationships between calcium levels and all-cause mortality, adjusting for relevant factors.
Main Results:
- Low total serum calcium was associated with a 1.83-fold increased adjusted hazard ratio (HR) for 1-year all-cause death compared to normal levels.
- High albumin-adjusted calcium levels in women showed a >3-fold increased HR for 1-year all-cause death compared to normal levels; no association was found in men.
- Non-linear associations were confirmed, with increased mortality risk at both extremes of total and albumin-adjusted calcium levels, particularly in women.
Conclusions:
- Serum calcium levels serve as a significant marker for mortality in acute stroke patients.
- The association between serum calcium and mortality is non-linear, with risks elevated at both low and high concentration extremes.
- Optimal long-term survival following acute stroke appears to be associated with maintaining serum calcium levels within a specific physiological range.
Background:
Calcium concentrations in serum are maintained within an exquisitely narrow range. Our aim was to examine the association between serum calcium and albumin-adjusted calcium (calcium(adj)) levels and stroke outcome in a cohort of unselected patients with acute stroke.
Methods:
Consecutive patients hospitalized due to acute stroke (ischemic or intracerebral hemorrhage) throughout a large medical center were systematically assessed and followed for 1 year. Baseline total calcium and calcium(adj) levels were collapsed into groups of low (<8.6 mg/dl), normal (8.7-9.9 mg/dl) and high (>10 mg/dl) levels and linear and quadratic relations with outcome were examined.
Result:
Among 784 patients (mean age 70.7 ± 12.5 years, 42.5% females), the mean ± SD total calcium level was 9.3 ± 0.6 mg/dl. For total calcium, the adjusted hazard ratio (HR) for all-cause death over 1 year was 1.83 [95% confidence interval (CI) 1.22-2.75] among patients with low versus normal levels. For calcium(adj), the adjusted HR for all-cause death among women was over 3-fold higher among patients with high calcium(adj) levels versus those with normal levels (3.31; 95% CI 1.70-6.46), while no such associations were observed among men. In models developed to estimate the linear and quadratic relations, each unit increment in total calcium squared was associated with an increased adjusted HR of all-cause death over 1 year (p = 0.02) confirming nonlinear associations, and each unit increment in calcium(adj) squared was associated with an increased adjusted HR of all-cause death over 1 year among women (p < 0.001) but not among men (p = 0.70).
Conclusions:
Serum calcium concentrations are a marker of mortality in acute stroke patients, but the associations are not linear, increasing at both extremes of calcium levels. Our findings suggest that long-term survival is optimal in a distinct range of serum calcium levels.
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