The association between albumin-corrected calcium and prognosis in patients with cardiac arrest: a retrospective study based on the MIMIC-IV database
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Published on: November 3, 2023
Lei Zhong1,2, Jianhong Lu1,2, Xu Sun3,2
1Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, 313000, China.
Insights
Albumin-corrected calcium (ACC) levels outside the moderate range are linked to higher mortality in cardiac arrest (CA) survivors. Both low and high ACC are independent risk factors for 90-day and 360-day mortality in CA patients.
Area of Science:
- Cardiology
- Critical Care Medicine
- Clinical Chemistry
Background:
- Cardiac arrest (CA) presents a significant global health challenge with high mortality rates.
- Early and accurate prognosis determination is crucial for managing CA patients.
- The relationship between albumin-corrected calcium (ACC) and CA patient outcomes requires further investigation.
Purpose of the Study:
- To investigate the correlation between albumin-corrected calcium (ACC) levels and the prognosis of patients following cardiac arrest (CA).
- To identify potential cut-off values of ACC associated with mortality risk in CA patients.
Main Methods:
- Retrospective analysis of the Medical Information Mart for Intensive Care IV database.
- Categorization of patients into low, moderate, and high ACC groups based on Restricted Cubic Spline (RCS) analysis cut-off values (8.86 and 10.32).
- Application of Least Absolute Shrinkage and Selection Operator (LASSO) regression, Inverse Probability Treatment Weighting (IPTW), Kaplan-Meier curves, and Cox regression analyses to assess mortality risk.
Main Results:
- RCS analysis revealed a non-linear relationship between ACC and 90-day/360-day mortality.
- Both low ( < 8.86) and high ( > 10.32) ACC groups were identified as independent risk factors for 90-day and 360-day all-cause mortality.
- Kaplan-Meier curves showed significantly lower cumulative survival rates in the low and high ACC groups compared to the moderate ACC group.
Conclusions:
- Elevated or reduced levels of albumin-corrected calcium (ACC) are independently associated with increased 90-day and 360-day mortality in cardiac arrest patients.
- Clinicians should pay close attention to both low and high ACC levels in cardiac arrest patients for risk stratification and management.
- The findings highlight the prognostic significance of ACC in the post-cardiac arrest setting.
Background:
Cardiac arrest (CA) is one of the leading causes of death globally, characterized by high incidence and mortality. It is of particular significance to determine the prognosis of patients with CA early and accurately. Therefore, we aim to investigate the correlation between albumin-corrected calcium (ACC) and the prognosis in patients diagnosed with CA.
Methods:
We retrospectively collected data from medical information mart for intensive care IV database. Patients were divided into two groups (survival and non-survival groups), according to the 90-day prognosis. In the Restricted cubic spline (RCS) analysis, the cut-off values (8.86 and 10.32) were obtained to categorize patients into three groups: low ACC group (< 8.86), moderate ACC group (8.86-10.32), and high ACC group (> 10.32). The least absolute shrinkage and selection operator with a ten-fold cross-validation regression analysis was performed to identify variables linked to the mortality. The inverse probability treatment weighting (IPTW) was used to address the confounding factors, and a weighted cohort was generated. RCS, Kaplan-Meier curve, and Cox regression analyses were used to explore the relationship between ACC and the mortality. Sensitivity analysis was employed to validate the stability of the results.
Results:
Cut-off values for ACC of 8.86 and 10.32 were determined. RCS analyses showed that there was an overall non-linear trend relationship between ACC and the risk of 90-day and 360-day mortalities. After IPTW adjustment, compared to the moderate ACC group, the 90-day and 360-day mortalities in the high ACC group were higher (P < 0.05). The Cox analyses before and after IPTW adjustment showed that both low ACC and high ACC group were independent risk factors for 90-day and 360-day all-cause mortality in patients with CA (P < 0.05). The results obtained from sensitivity analyses indicated the stability of the findings. The Kaplan-Meier survival curves indicated that 90- and 360-day cumulative survival rates in the low ACC and high ACC groups were lower than that in the moderate ACC group (χ2 = 11.350, P = 0.003; χ2 = 14.110, P = 0.001).
Conclusion:
Both low ACC (< 8.86) and high ACC groups (> 10.32) were independent risk factors for 90-day and 360-day all-cause mortality in patients with CA (P < 0.05). For those CA patients with high and low ACC, it deserved the attention of clinicians.
