The Prognostic Value of Calcium in Post-Cardiovascular Surgery Patients in the Intensive Care Unit
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Published on: May 10, 2021
Siwei Bi1, Ruiqi Liu2, Jingyi Li1
1West China School of Medicine, Sichuan University, Chengdu, China.
Insights
Mildly low ionized calcium (iCa) levels in intensive care unit (ICU) patients after cardiovascular surgery are linked to worse outcomes. This finding suggests iCa could be an independent prognostic factor for post-cardiovascular surgery patients.
Area of Science:
- Critical Care Medicine
- Cardiovascular Surgery
- Clinical Chemistry
Background:
- Existing research on calcium's prognostic value in post-cardiovascular surgery (PCS) patients is limited by sample size and study design.
- Investigating both total calcium (tCa) and ionized calcium (iCa) is crucial for understanding patient outcomes.
Purpose of the Study:
- To assess the association of tCa and iCa with short- and long-term mortality in ICU patients post-cardiovascular surgery.
- To identify potential prognostic markers for PCS patients.
Main Methods:
- Utilized data from the MIMIC-III and eICU Collaborative Research Databases to identify PCS patients.
- Employed multivariate regression and propensity score estimation to analyze the relationship between calcium levels and outcomes, with 28-day mortality as the primary outcome.
Main Results:
- Included 6122 (MIMIC III) and 914 (eICU) PCS patients; mild hypo-iCa and hypo-tCa groups were most common.
- Mild hypo-iCa was significantly associated with worse short- and long-term prognosis, reduced ventilation use, longer ICU/hospital stays, and increased 7-day acute kidney injury.
Conclusions:
- Mildly low ionized calcium (0.9-1.15 mmol/L) within the first day of ICU admission is an independent prognostic factor for PCS patients.
- iCa monitoring may aid in risk stratification and management of post-cardiovascular surgery patients.
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.
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