Admission Serum Calcium Levels Improve the GRACE Risk Score Prediction of Hospital Mortality in Patients With Acute Coronary Syndrome

Abstract

Background: The Global Registry of Acute Coronary Events (GRACE) risk score has been extensively validated to predict risk during hospitalization in patients with acute coronary syndrome (ACS). Recently, serum calcium has been suggested as an independent predictor for in-hospital mortality in patients with ST-segment elevation myocardial infarction; however, the relationship between the 2 has not been evaluated. Hypothesis: The combination of GRACE risk score and serum calcium could provide better performance in risk prediction. Methods: The study enrolled 2229 consecutive patients with ACS. Independent predictors were identified by a multivariate logistic regression model. The incremental prognostic value added by serum calcium to the GRACE score was evaluated by receiver operating characteristic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Area under the curve increased significantly after adding serum calcium to the GRACE score (0.685 vs 0.746; Z = 2.617, P = 0.009). Furthermore, inclusion of serum calcium in the GRACE score enhanced NRI (0.524; P = 0.009) and IDI (0.011; P = 0.003). Conclusions: Lower serum calcium level on admission is a possible indicator of increased risk of in-hospital mortality in ACS patients. Inclusion of serum calcium in the GRACE score may lead to a more accurate prediction of this risk. Large prospective studies are needed to confirm this finding.

Serum ionised calcium and the risk of acute respiratory failure in hospitalised patients: a single-centre cohort study in the USA

“…2 This last portion is strictly controlled by parathyroid hormone and vitamin D. 3 Total serum calcium concentration substantially varies on the serum concentration of albumin and hydration status without any alteration in the concentration of ionised calcium. [4][5][6][7] Hence, measuring only total serum calcium might be misleading. The gold standard for assessing calcium status is to measure ionised calcium.…”

Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

“…Serum calcium levels are affected by several important factors including vitamin D and parathyroid hormone (PTH), serum phosphate, and magnesium levels [5,[8][9][10]. Abnormalities of calcium derangements and changes in serum calcium levels are common in clinical practice, especially among critically ill patients with prevalence up to 88% [5,[10][11][12][13][14][15].…”

Admission calcium levels and risk of acute kidney injury in hospitalised patients

“…The findings of this study suggest an increased risk of AKI not only in patients with elevated serum calcium ≥9.0 mg/dL, but also in those with reduced serum calcium ≤7.9 mg/dL on admission. Calcium plays a vital function in almost all biological processes including enzymatic activity, cardiac contraction and relaxation, and contraction of vascular smooth muscle[36][37][38][39] and studies have demonstrated associations of hypocalcaemia with poor left ventricular ejection fraction, 39-43 volume overload,44 and cardiac arrhythmias,40,41 which may result in AKI episodes. Although, in our sensitivity analysis of corrected serum calcium levels and risk of AKI, the association between decreased corrected serum calcium ≤7.9 mg/dL and risk of AKI was not statistically significant, this is likely because of underpower as there were only 133 patients with corrected serum calcium ≤7.9 mg/dL.There are several limitations in this study.…”