Predictive accuracy of serum total calcium for both critically high and critically low ionized calcium in critical illness

Hu, Zhide; Huang, Yuan-Lan; Wang, Meiying; Hu, Gejile; Han, Yang

doi:10.1002/jcla.22589

Cited by 13 publications

(8 citation statements)

References 19 publications

(41 reference statements)

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“…Nonetheless, it could be the degree of severity of the disease that explains this association. Low serum ionized calcium might be related to severity of the illness or sepsis [23][24][25] . The inflammatory cytokines during the illness impair PTH secretion from parathyroid gland along with resistance to PTH at the end-organs 26 .…”

Section: Discussionmentioning

confidence: 99%

Impact of admission serum ionized calcium levels on risk of acute kidney injury in hospitalized patients

Cheungpasitporn

Chewcharat

Mao

et al. 2020

Sci Rep

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this study aimed to investigate the risk of acute kidney injury (AKi) in hospitalized patients based on admission serum ionized calcium levels. this is a cohort study of all hospitalized adult patients, from January 2009 to December 2013 at a tertiary referral hospital, who had available serum ionized calcium at the time of admission. We excluded patients who had end-stage kidney disease or AKi at admission. We stratified admission serum ionized calcium into 6 groups; ≤ 4.39, 4.40-4.59, 4.60-4.79, 4.80-4.99, 5.00-5.19, and ≥ 5.20 mg/dL. We used serum creatinine criterion of KDIGO definition for diagnosis of AKi. We performed logistic regression analysis to assess the risk of in-hospital AKi occurrence based on admission serum ionized calcium, using serum ionized calcium of 5.00-5.19 mg/ dL as the reference group. We studied a total of 25,844 hospitalized patients. Of these, 3,294 (12.7%) developed AKI in hospital, and 622 (2.4%) had AKI stage 2 or 3. We observed a U-shaped association between admission serum ionized calcium and in-hospital AKi, with nadir in-hospital AKi was in serum ionized calcium of 5.00-5.19 mg/dL. After adjustment for confounders, low serum ionized calcium of 4.40-4.59, ≤ 4.39 mg/dL and elevated serum ionized calcium ≥ 5.20 mg/dL were associated with increased risk of AKI with odds ratio of 1.33 (95% CI 1.14-1.56), 1.45 (95% CI 1.21-1.74), and 1.26 (95% CI 1.04-1.54), respectively. Both hypocalcemia, and hypercalcemia at the time of admission were associated with an increased risk of hospital-acquired AKi.

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Section: Discussionmentioning

confidence: 99%

Impact of admission serum ionized calcium levels on risk of acute kidney injury in hospitalized patients

Cheungpasitporn

Chewcharat

Mao

et al. 2020

Sci Rep

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“…The use of the MIMIC-III and MIMIC-IV databases was approved by the Institutional Review Board of the Beth Israel Deaconess Medical Center and Massachusetts Institute of Technology, and all patient information in the database is anonymous, so informed consent was not required ( 19 , 20 ).…”

Section: Methodsmentioning

confidence: 99%

A New Scoring System for Predicting In-hospital Death in Patients Having Liver Cirrhosis With Esophageal Varices

Zhang

Wang

et al. 2021

Front. Med.

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Introduction: Liver cirrhosis is caused by the development of various acute and chronic liver diseases. Esophageal varices is a common and serious complication of liver cirrhosis during decompensation. Despite the development of various treatments, the prognosis for liver cirrhosis with esophageal varices (LCEV) remains poor. We aimed to establish and validate a nomogram for predicting in-hospital death in LCEV patients.Methods: Data on LCEV patients were extracted from the Medical Information Mart for Intensive Care III and IV (MIMIC-III and MIMIC-IV) database. The patients from MIMIC-III were randomly divided into training and validation cohorts. Training cohort was used for establishing the model, validation and MIMIC-IV cohorts were used for validation. The independent prognostic factors for LCEV patients were determined using the least absolute shrinkage and selection operator (LASSO) method and forward stepwise logistic regression. We then constructed a nomogram to predict the in-hospital death of LCEV patients. Multiple indicators were used to validate the nomogram, including the area under the receiver operating characteristic curve (AUC), calibration curve, Hosmer-Lemeshow test, integrated discrimination improvement (IDI), net reclassification index (NRI), and decision curve analysis (DCA).Results: Nine independent prognostic factors were identified by using LASSO and stepwise regressions: age, Elixhauser score, anion gap, sodium, albumin, bilirubin, international normalized ratio, vasopressor use, and bleeding. The nomogram was then constructed and validated. The AUC value of the nomogram was 0.867 (95% CI = 0.832–0.904) in the training cohort, 0.846 (95% CI = 0.790–0.896) in the validation cohort and 0.840 (95% CI = 0.807–0.872) in the MIMIC-IV cohort. High AUC values indicated the good discriminative ability of the nomogram, while the calibration curves and the Hosmer-Lemeshow test results demonstrated that the nomogram was well-calibrated. Improvements in NRI and IDI values suggested that our nomogram was superior to MELD-Na, CAGIB, and OASIS scoring system. DCA curves indicated that the nomogram had good value in clinical applications.Conclusion: We have established the first prognostic nomogram for predicting the in-hospital death of LCEV patients. The nomogram is easy to use, performs well, and can be used to guide clinical practice, but further external prospective validation is still required.

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“…Further studies are urgently needed to examine causes of hypocalcemia in hospitalized patients with COVID-19. Measurement of ionized serum calcium should be done because it is more accurate than albumin-corrected calcium in critically ill patients [16]. In addition, plasma levels of PTH, magnesium, and 25-hydroxy vitamin D levels should be measured in all patients with hypocalcemia to clarify the etiology of hypocalcemia.…”

Section: Conclusion and Current Needsmentioning

confidence: 99%

Prognostic value of hypocalcemia in COVID-19

Mikhail¹,

Wali²

2020

Integr Food Nutr Metab

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Background: Preliminary data suggest that hypocalcemia is common among patients with coronavirus 2019 admitted to the hospital.Objective: To examine the prognostic value of hypocalcemia in the setting of COVID-19.Methods: Literature search (Pubmed) until September 15, 2020. Search terms include hypocalcemia, COVID-19, mortality, complications. Retrospective studies are reviewed due to lack of randomized trials.Results: Hypocalcemia is the most common electrolyte abnormality in patients with COVID-19 admitted to the hospital after hyponatremia. Prevalence of hypocalcemia among hospitalized patients with COVID-19 ranges from 9.5% to 78% depending on the definition of hypocalcemia and patients' characteristics. In most cases, hypocalcemia is mild to moderate biochemically. Hypocalcemia is a risk factor for hospitalization of patients with COVID-19. In already hospitalized patients, hypocalcemia is significantly associated with increase severity of COVID-19 and its complications including multi-organ failure, intensive care unit (ICU) admission, need for mechanical ventilation, acute respiratory distress syndrome (ARDS), and death. Hypocalcemia is significantly correlated with inflammatory markers of COVID-19. Causes of hypocalcemia in COVID-19 patients are unclear, but vitamin D deficiency may be a contributing factor. Conclusions: Hypocalcemia is common in hospitalized patients with COVID-19 and carries unfavorable outcomes. Further studies are needed to examine causes of hypocalcemia in COVID-19 and to see whether normalization of circulating calcium levels improve prognosis.

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Predictive accuracy of serum total calcium for both critically high and critically low ionized calcium in critical illness

Cited by 13 publications

References 19 publications

Impact of admission serum ionized calcium levels on risk of acute kidney injury in hospitalized patients

Impact of admission serum ionized calcium levels on risk of acute kidney injury in hospitalized patients

A New Scoring System for Predicting In-hospital Death in Patients Having Liver Cirrhosis With Esophageal Varices

Prognostic value of hypocalcemia in COVID-19

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