Hospital-Acquired Serum Ionized Calcium Derangements and Their Associations with In-Hospital Mortality

doi:10.3390/medicines7110070

. 2020 Nov 19;7(11):70.

doi: 10.3390/medicines7110070.

Hospital-Acquired Serum Ionized Calcium Derangements and Their Associations with In-Hospital Mortality

Affiliations

¹ Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
² Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA 17101, USA.
³ Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
⁴ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
⁵ Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA.
⁶ Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA.
⁷ Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.
⁸ Division of Pulmonary, Critical Care and Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA.

PMID: 33227914
PMCID: PMC7699179
DOI: 10.3390/medicines7110070

Hospital-Acquired Serum Ionized Calcium Derangements and Their Associations with In-Hospital Mortality

Charat Thongprayoon et al. Medicines (Basel). 2020.

. 2020 Nov 19;7(11):70.

doi: 10.3390/medicines7110070.

Affiliations

¹ Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
² Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA 17101, USA.
³ Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
⁴ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
⁵ Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA.
⁶ Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA.
⁷ Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.
⁸ Division of Pulmonary, Critical Care and Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA.

PMID: 33227914
PMCID: PMC7699179
DOI: 10.3390/medicines7110070

Abstract

Background: The objective of this study was to report the incidence of in-hospital serum ionized calcium derangement and its impact on mortality. Methods: We included 12,599 non-dialytic adult patients hospitalized at a tertiary medical center from January 2009 to December 2013 with normal serum ionized calcium at admission and at least 2 in-hospital serum ionized calcium values. Using serum ionized calcium of 4.60-5.40 mg/dL as the normal reference range, in-hospital serum ionized calcium levels were categorized based on the presence of hypocalcemia and hypercalcemia in hospital. We performed logistic regression to assess the relationship of in-hospital serum ionized calcium derangement with mortality. Results: Fifty-four percent of patients developed new serum ionized calcium derangements: 42% had in-hospital hypocalcemia only, 4% had in-hospital hypercalcemia only, and 8% had both in-hospital hypocalcemia and hypercalcemia. In-hospital hypocalcemia only (OR 1.28; 95% CI 1.01-1.64), in-hospital hypercalcemia only (OR 1.64; 95% CI 1.02-2.68), and both in-hospital hypocalcemia and hypercalcemia (OR 1.73; 95% CI 1.14-2.62) were all significantly associated with increased in-hospital mortality, compared with persistently normal serum ionized calcium levels. Conclusions: In-hospital serum ionized calcium derangements affect more than half of hospitalized patients and are associated with increased in-hospital mortality.

Keywords: calcium; electrolytes; hospitalization; hypercalcemia; hypocalcemia; mortality.

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Conflict of interest statement

The authors declare no conflict of interest.

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Derivation and comparison of formulae for the adjustment of total calcium.
Phylactou M, Comninos AN, Salih A, Labib M, Eng PC, Clarke SA, Moore P, Tan T, Cegla J, Dhillo WS, Abbara A. Phylactou M, et al. Front Endocrinol (Lausanne). 2023 May 12;14:1070443. doi: 10.3389/fendo.2023.1070443. eCollection 2023. Front Endocrinol (Lausanne). 2023. PMID: 37251673 Free PMC article.

References

1. Peacock M. Calcium metabolism in health and disease. Clin. J. Am. Soc. Nephrol. 2010;5(Suppl. 1):S23–S30. doi: 10.2215/CJN.05910809. - DOI - PubMed
1. Desai T.K., Carlson R.W., Geheb M.A. Prevalence and clinical implications of hypocalcemia in acutely ill patients in a medical intensive care setting. Am. J. Med. 1988;84:209–214. doi: 10.1016/0002-9343(88)90415-9. - DOI - PubMed
1. Akirov A., Gorshtein A., Shraga-Slutzky I., Shimon I. Calcium levels on admission and before discharge are associated with mortality risk in hospitalized patients. Endocrine. 2017;57:344–351. doi: 10.1007/s12020-017-1353-y. - DOI - PubMed
1. Thongprayoon C., Cheungpasitporn W., Chewcharat A., Mao M.A., Bathini T., Vallabhajosyula S., Thirunavukkarasu S., Kashani K.B. Impact of admission serum ionized calcium levels on risk of acute kidney injury in hospitalized patients. Sci. Rep. 2020;10:12316. doi: 10.1038/s41598-020-69405-0. - DOI - PMC - PubMed
1. Thongprayoon C., Cheungpasitporn W., Chewcharat A., Mao M.A., Kashani K.B. Serum ionised calcium and the risk of acute respiratory failure in hospitalised patients: A single-centre cohort study in the USA. BMJ Open. 2020;10:e034325. doi: 10.1136/bmjopen-2019-034325. - DOI - PMC - PubMed

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[1] Peacock M. Calcium metabolism in health and disease. Clin. J. Am. Soc. Nephrol. 2010;5(Suppl. 1):S23–S30. doi: 10.2215/CJN.05910809. - DOI - PubMed

[2] Peacock M. Calcium metabolism in health and disease. Clin. J. Am. Soc. Nephrol. 2010;5(Suppl. 1):S23–S30. doi: 10.2215/CJN.05910809. - DOI - PubMed

[3] Desai T.K., Carlson R.W., Geheb M.A. Prevalence and clinical implications of hypocalcemia in acutely ill patients in a medical intensive care setting. Am. J. Med. 1988;84:209–214. doi: 10.1016/0002-9343(88)90415-9. - DOI - PubMed

[4] Desai T.K., Carlson R.W., Geheb M.A. Prevalence and clinical implications of hypocalcemia in acutely ill patients in a medical intensive care setting. Am. J. Med. 1988;84:209–214. doi: 10.1016/0002-9343(88)90415-9. - DOI - PubMed

[5] Akirov A., Gorshtein A., Shraga-Slutzky I., Shimon I. Calcium levels on admission and before discharge are associated with mortality risk in hospitalized patients. Endocrine. 2017;57:344–351. doi: 10.1007/s12020-017-1353-y. - DOI - PubMed

[6] Akirov A., Gorshtein A., Shraga-Slutzky I., Shimon I. Calcium levels on admission and before discharge are associated with mortality risk in hospitalized patients. Endocrine. 2017;57:344–351. doi: 10.1007/s12020-017-1353-y. - DOI - PubMed

[7] Thongprayoon C., Cheungpasitporn W., Chewcharat A., Mao M.A., Bathini T., Vallabhajosyula S., Thirunavukkarasu S., Kashani K.B. Impact of admission serum ionized calcium levels on risk of acute kidney injury in hospitalized patients. Sci. Rep. 2020;10:12316. doi: 10.1038/s41598-020-69405-0. - DOI - PMC - PubMed

[8] Thongprayoon C., Cheungpasitporn W., Chewcharat A., Mao M.A., Bathini T., Vallabhajosyula S., Thirunavukkarasu S., Kashani K.B. Impact of admission serum ionized calcium levels on risk of acute kidney injury in hospitalized patients. Sci. Rep. 2020;10:12316. doi: 10.1038/s41598-020-69405-0. - DOI - PMC - PubMed

[9] Thongprayoon C., Cheungpasitporn W., Chewcharat A., Mao M.A., Kashani K.B. Serum ionised calcium and the risk of acute respiratory failure in hospitalised patients: A single-centre cohort study in the USA. BMJ Open. 2020;10:e034325. doi: 10.1136/bmjopen-2019-034325. - DOI - PMC - PubMed

[10] Thongprayoon C., Cheungpasitporn W., Chewcharat A., Mao M.A., Kashani K.B. Serum ionised calcium and the risk of acute respiratory failure in hospitalised patients: A single-centre cohort study in the USA. BMJ Open. 2020;10:e034325. doi: 10.1136/bmjopen-2019-034325. - DOI - PMC - PubMed

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Hospital-Acquired Serum Ionized Calcium Derangements and Their Associations with In-Hospital Mortality

Affiliations

Hospital-Acquired Serum Ionized Calcium Derangements and Their Associations with In-Hospital Mortality

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Affiliations

Abstract

Conflict of interest statement

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Abstract

Conflict of interest statement

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