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Hypercalcemia in hospitalized patients: prevalence, etiology and mortality predictors in a tertiary internal medicine
Ertunç Şimdi1, Mehmet Uzunlulu2, Erhan Eken2
1Department of Internal Medicine, Istanbul Medeniyet University Göztepe Prof. Dr. Süleyman Yalcin Training and Research Hospital, Istanbul, Türkiye. ertuncsimdi@gmail.com.
Insights
Hypercalcemia in hospitalized patients, often linked to malignancy and older age, carries a high mortality risk. Early risk factor identification and cause-specific treatment are crucial for better patient outcomes.
Area of Science:
- Internal Medicine
- Endocrinology
- Oncology
Background:
- Hypercalcemia is a serious electrolyte disorder common in hospitalized individuals.
- Its diverse causes and outcomes necessitate a thorough understanding for improved patient care.
Purpose of the Study:
- To investigate the prevalence, causes, and mortality risk factors of hypercalcemia in hospitalized internal medicine patients.
- To analyze demographic, clinical, and laboratory features associated with hypercalcemia and its outcomes.
Main Methods:
- Retrospective observational cohort study of adult patients hospitalized with hypercalcemia (corrected calcium ≥ 10.2 mg/dL) between January 2022 and January 2024.
- Data collection included demographics, comorbidities, laboratory parameters, etiology, treatments, and outcomes.
- Univariate and multivariate analyses were used to identify mortality risk factors.
Main Results:
- The prevalence of hypercalcemia was 6% (190/3157 patients), with a mean age of 72.3 years.
- Malignancy was the leading cause (49.5%), followed by other and undetermined causes.
- In-hospital mortality was 24.2%, significantly associated with male sex, malignancy, elevated AST, hypoalbuminemia, and age 65-80 years.
Conclusions:
- Hypercalcemia in hospitalized patients is frequently associated with malignancy and advanced age, contributing to high mortality rates.
- Identifying specific risk factors and tailoring management based on etiology are essential for improving survival.
Introduction:
Hypercalcemia is a potentially life-threatening electrolyte disorder with diverse etiologies and clinical manifestations, frequently encountered in hospitalized patients. Understanding its prevalence, causes, and associated outcomes in the inpatient setting is crucial for improving patient management and prognosis. The objectives were to determine the prevalence, etiological distribution, clinical and demographic characteristics, comorbidities, laboratory features, and mortality risk factors of hypercalcemia among patients admitted to an internal medicine clinic in a tertiary university hospital.
Material And Methods:
This retrospective, observational cohort study included adults (≥ 18 years) hospitalized with hypercalcemia (corrected calcium ≥ 10.2 mg/dL, confirmed twice at least 24 hours apart) between January 2022 and January 2024. Hypercalcemia severity was classified as mild, moderate, or severe. Etiological categories included malignancy-associated, endocrine-related, vitamin D-mediated, other, and undetermined. Demographics, comorbidities, laboratory parameters, treatments, and outcomes were recorded. Univariate and multivariate analyses were performed to identify mortality risk factors.
Results:
Among 3,157 admissions, 190 patients (prevalence 6%) had confirmed persistent hypercalcemia (mean age 72.3 ± 13.1 years; 61.6% female). Malignancy was the leading cause (49.5%), followed by other causes (24.7%), undetermined (15.8%), endocrine (8.4%), and vitamin D-mediated (1.6%). Severe hypercalcemia (11.6%) was predominantly associated with malignancy. Overall in-hospital mortality was 24.2%, with male sex, malignancy, solid tumors, elevated aspartate aminotransferase (AST), hypoalbuminemia, and age 65-80 years independently associated with mortality. Survival was significantly worse in malignancy-related cases. The optimal parathyroid hormone (PTH) threshold for predicting malignancy was identified as ≤ 12.61 pg/mL. This cut-off demonstrated a sensitivity of 71.4% and a specificity of 91.3%.
Conclusions:
Hypercalcemia in hospitalized patients is predominantly associated with malignancy and advanced age, and is linked with high mortality. Early identification of risk factors and etiology-driven management are critical for improving outcomes.
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