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The Relationship Between Ionized Calcium Levels and Prognosis in Patients with Spontaneous Subarachnoid Hemorrhage

Melike Kucukceylan1, Muge Gulen1, Salim Satar1

  • 1Department of Emergency Medicine, Health Science University, Adana City Training and Research Hospital, Adana, Turkey.

World Neurosurgery
|June 23, 2024
PubMed

Insights

Low ionized calcium levels in emergency department patients with spontaneous subarachnoid hemorrhage predict poor outcomes and mortality. This accessible blood gas parameter aids in predicting functional independence at discharge.

Area of Science:

  • Neurology
  • Critical Care Medicine
  • Clinical Chemistry

Background:

  • Serum calcium is vital for cardiac function, vascular tone, and coagulation.
  • Spontaneous subarachnoid hemorrhage (SAH) is a critical neurological event.
  • Understanding prognostic markers in SAH is crucial for patient management.

Purpose of the Study:

  • To investigate if ionized calcium levels predict outcomes in patients with spontaneous SAH.
  • To assess the correlation between initial ionized calcium and patient prognosis.
  • To determine the utility of ionized calcium in emergency department settings for SAH patients.

Main Methods:

  • Retrospective cross-sectional case series of 267 adult patients with spontaneous SAH.
  • Data collected included demographics, comorbidities, vital signs, laboratory results, and SAH severity scores.
  • Outcomes assessed included mortality, need for mechanical ventilation/inotropes, and functional status (Rankin score).

Main Results:

  • Mortality rate was 34.8%, significantly higher in patients with low initial calcium levels (P=0.024).
  • Ionized calcium independently predicted mortality during complication development (OR: 0.945, P=0.034).
  • Lower initial ionized calcium levels correlated with poorer neurological outcomes (Rankin 3-6, P=0.002).

Conclusions:

  • Ionized calcium is a valuable, accessible parameter for predicting outcomes in spontaneous SAH.
  • It assists clinicians in forecasting functional independence and mortality at discharge.
  • Monitoring ionized calcium in the emergency department can inform treatment strategies for SAH patients.
Abstract

Keywords:
Ionized calciumMortalityRankin scoreSpontaneous subarachnoid hemorrhage

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