Hypocalcemia is associated with adverse clinical course in patients with upper gastrointestinal bleeding

Korytny, Alexander; Klein, Amir; Marcusohn, Erez; Freund, Yaacov; Neuberger, Ami; Raz, Aeyal; Miller, Asaf; Epstein, Danny

doi:10.1007/s11739-021-02671-6

Cited by 7 publications

(4 citation statements)

References 33 publications

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“…To the best of our knowledge, only one study evaluated the association between Ca ++ and clinical outcomes of patients with UGIB. This study was published by our group and was based on the same cohort of patients [23]. Our previous study included 1,345 patients with NV-UGIB for whom Ca ++ was measured 24 h before or after endoscopy and did not include endoscopic findings or interventions.…”

Section: Discussionmentioning

confidence: 99%

Admission Hypocalcemia and the Need for Endoscopic and Clinical Interventions among Patients with Upper Gastrointestinal Bleeding

Korytny,

Mazzawi,

Marcusohn

et al. 2023

Eur Surg Res

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Introduction: Calcium is an essential co-factor in the coagulation cascade and hypocalcemia is associated with adverse outcomes in bleeding patients, including trauma patients, women with postpartum hemorrhage, and patients with intracranial hemorrhage. In this retrospective, single-center, cohort study, we aimed to determine whether admission ionized calcium (Ca++) is associated with higher rates of therapeutic interventions among patients presenting with acute non-variceal upper gastrointestinal bleeding (NV-UGIB). Methods: Adult patients admitted due to NV-UGIB between 1/2009-4/2020 were identified. The primary outcome was defined as a need for clinical intervention (two or more packed cell transfusions, need for endoscopic, surgical, or angiographic intervention). Univariate and multivariable logistic regression analyses were performed to determine whether Ca++ was an independent predictor of the need for therapeutic interventions. Propensity score matching was performed to adjust the imbalances of covariates between the groups. Results: A total of 434 patients were included, of whom 148 (34.1%) had hypocalcemia (Ca++<1.15mmol/L). Patients with hypocalcemia were more likely to require therapeutic interventions than those without hypocalcemia (48.0% vs. 18.5%, p<0.001). Specifically, patients with hypocalcemia were more likely to require endoscopic intervention for control of bleeding (25.0% vs. 15.7%, p=0.03) and require multiple packed cell transfusions (6.8% vs. 0.3%, p<0.001). Additionally, they had significantly longer hospital stay (5.0 days [IQR 3.0-8.0] vs. 4.0 days [IQR 3.0-6.0], p=0.01). After adjusting for multiple covariates, Ca++ was an independent predictor of the need for therapeutic intervention (aOR 1.62, 95% CI 1.22–2.14, p<0.001). The addition of Ca++ to Modified Glasgow Blatchford score improved its accuracy in the prediction of therapeutic intervention from AUC of 0.68 (95% CI 0.63-0.72) to 0.72 (95% CI 0.67-0.76), p=0.02. After incorporation of the propensity score, the results did not change significantly. Conclusion: These findings suggest that hypocalcemia is common and is associated with an adverse clinical course in patients with NV-UGIB. Measurement of Ca++ on admission may facilitate risk stratification in these patients. Trials are needed to assess whether correction of hypocalcemia will lead to improved outcomes.

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Section: Discussionmentioning

confidence: 99%

Admission Hypocalcemia and the Need for Endoscopic and Clinical Interventions among Patients with Upper Gastrointestinal Bleeding

Korytny,

Mazzawi,

Marcusohn

et al. 2023

Eur Surg Res

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“…Calcium is an important coagulation factor that participates in different cellular processes [ 9 ]. Hypocalcemia is a common biochemical abnormality and has been recognized as a prognostic marker of coronary heart disease, chronic kidney disease, acute myocardial infarction and gastrointestinal bleeding [ 10 – 13 ]. Furthermore, evidence is mounting that hypocalcemia is associated with short-term mortality after APE [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Additive prognostic value of serum calcium to the ESC risk stratification in patients with acute pulmonary embolism

et al. 2023

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Background Hypocalcemia has been shown to be involved in the adverse outcomes of acute pulmonary embolism (APE). We aimed to determine the incremental value of adding hypocalcemia, defined as serum calcium level ≤ 2.12 mmol/L, on top of the European Society of Cardiology (ESC) prognostic algorithm, for the prediction of in-hospital mortality in APE patients, which in turn could lead to the optimization of APE management. Methods This study was conducted at West China Hospital of Sichuan University from January 2016 to December 2019. Patients with APE were retrospectively analyzed and divided into 2 groups based on serum calcium levels. Associations between hypocalcemia and adverse outcomes were assessed by Cox analysis. The accuracy of risk stratification for in-hospital mortality was assessed with the addition of serum calcium to the current ESC prognostic algorithm. Results Among 803 patients diagnosed with APE, 338 (42.1%) patients had serum calcium levels ≤ 2.12 mmol/L. Hypocalcemia was significantly associated with higher in-hospital and 2-year all-cause mortality compared to the control group. The addition of serum calcium to ESC risk stratification enhanced net reclassification improvement. Low-risk group with serum calcium level > 2.12 mmol/L had a 0% mortality rate, improving the negative predictive value up to 100%, while high-risk group with serum calcium level ≤ 2.12 mmol/L indicated a higher mortality of 25%. Conclusion Our study identified serum calcium as a novel predictor of mortality in patients with APE. In the future, serum calcium may be added to the commonly used ESC prognostic algorithm for better risk stratification of patients suffering from APE.

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“…Hypocalcemia is a common biochemical abnormality and has been recognized as a prognostic marker of coronary heart disease, chronic kidney disease, acute myocardial infarction and gastrointestinal bleeding [10][11][12][13]. Furthermore, evidence is mounting that hypocalcemia is associated with short-term mortality after APE [14,15].…”

Section: Introductionmentioning

confidence: 99%

Additive prognostic value of serum calcium to the ESC risk stratification in patients with acute pulmonary embolism

Zhang

Ali

Liu

et al. 2022

Preprint

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Background Hypocalcemia has been shown to be involved in the adverse outcomes of acute pulmonary embolism (APE). We aimed to determine the incremental value of adding hypocalcemia, defined as serum calcium level ≤ 2.12 mmol/L, on top of the European Society of Cardiology (ESC) prognostic algorithm, for the prediction of in-hospital mortality in APE patients, which in turn could lead to the optimization of APE management. Methods This study was conducted at West China Hospital of Sichuan University from January 2016 to December 2019. Patients with APE were retrospectively analyzed and divided into 2 groups based on serum calcium levels. Associations between hypocalcemia and adverse outcomes were assessed by Cox analysis. The accuracy of risk stratification for in-hospital mortality was assessed with the addition of serum calcium to the current ESC prognostic algorithm. Results Among 803 patients diagnosed with APE, 338 (42.1%) patients had serum calcium levels ≤ 2.12 mmol/L. Hypocalcemia was significantly associated with higher in-hospital and 2-year all-cause mortality compared to the control group. A serum calcium level ≤ 2.12 mmol/L in patients with ESC-defined low risk identified a group with a mortality of 2.5%, improving the negative predictive value up to 100%, while in high-risk patients, it indicated a group of high early mortality of 25%. Conclusion Our study identified serum calcium as a novel predictor of mortality in patients with APE. In the future, serum calcium may be added to the commonly used ESC prognostic algorithm for better risk stratification of patients suffering from APE.

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Hypocalcemia is associated with adverse clinical course in patients with upper gastrointestinal bleeding

Cited by 7 publications

References 33 publications

Admission Hypocalcemia and the Need for Endoscopic and Clinical Interventions among Patients with Upper Gastrointestinal Bleeding

Admission Hypocalcemia and the Need for Endoscopic and Clinical Interventions among Patients with Upper Gastrointestinal Bleeding

Additive prognostic value of serum calcium to the ESC risk stratification in patients with acute pulmonary embolism

Additive prognostic value of serum calcium to the ESC risk stratification in patients with acute pulmonary embolism

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