Impact of Changes in Serum Calcium Levels on In-Hospital Mortality
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Data Collection
2.3. Clinical Outcomes
2.4. Statistical Analysis
3. Results
3.1. Clinical Characteristics
3.2. Serum Calcium Change and In-Hospital Mortality
3.3. Direction of Serum Calcium Change and In-Hospital Mortality
4. Discussion
5. Conclusions
Author Contributions
Conflicts of Interest
References
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Variables | All | Change in Serum Calcium Level during Hospitalization (mg/dL) | |||||
---|---|---|---|---|---|---|---|
0–0.4 | 0.5–0.9 | 1.0–1.4 | 1.5–1.9 | ≥2.0 | p Value | ||
N | 9868 | 3200 | 3030 | 1575 | 817 | 1246 | |
Age (year) | 61 ± 17 | 63 ± 17 | 61 ± 17 | 60 ± 16 | 58 ± 16 | 60 ± 16 | <0.001 |
Male sex | 5398 (55) | 1808 (57) | 1664 (55) | 881 (56) | 429 (53) | 616 (49) | <0.001 |
Caucasian | 8841 (90) | 2892 (90) | 2731 (90) | 1405 (89) | 720 (88) | 1093 (88) | 0.04 |
Principal diagnosis | <0.001 | ||||||
- Cardiovascular | 1685 (17) | 648 (20) | 510 (17) | 220 (14) | 103 (13) | 204 (16) | |
- Hematology/oncology | 1681 (17) | 516 (16) | 489 (16) | 265 (17) | 155 (19) | 256 (21) | |
- Infectious disease | 675 (7) | 205 (6) | 183 (6) | 121 (8) | 43 (5) | 123 (10) | |
- Endocrine/metabolic | 582 (6) | 160 (5) | 151 (5) | 91 (6) | 46 (6) | 134 (11) | |
- Respiratory | 463 (5) | 174 (5) | 161 (5) | 67 (4) | 28 (3) | 33 (3) | |
- Gastrointestinal | 1301 (13) | 445 (14) | 438 (14) | 198 (13) | 105 (13) | 115 (9) | |
- Genitourinary | 797 (8) | 206 (6) | 200 (7) | 131 (8) | 106 (13) | 154 (12) | |
- Injury and poisoning | 1750 (18) | 496 (16) | 593 (20) | 341 (22) | 163 (20) | 157 (13) | |
- Other | 934 (9) | 350 (11) | 305 (10) | 141 (9) | 68 (8) | 70 (6) | |
Charlson comorbidity score | 2.5 ± 2.7 | 2.6 ± 2.8 | 2.5 ± 2.7 | 2.6 ± 2.7 | 2.4 ± 2.6 | 2.4 ± 2.5 | 0.22 |
Comorbidity | |||||||
- Coronary artery disease | 2147 (22) | 788 (25) | 680 (22) | 308 (20) | 142 (17) | 229 (18) | <0.001 |
- Congestive heart failure | 955 (10) | 363 (11) | 281 (9) | 142 (9) | 61 (7) | 108 (9) | 0.002 |
- Peripheral artery disease | 410 (4) | 165 (5) | 123 (4) | 52 (3) | 30 (4) | 40 (3) | 0.007 |
- Stroke | 796 (8) | 279 (9) | 277 (9) | 102 (6) | 51 (6) | 87 (7) | 0.002 |
- Diabetes mellitus | 2542 (26) | 858 (27) | 793 (26) | 380 (24) | 183 (22) | 328 (26) | 0.05 |
- Chronic obstructive pulmonary disease | 972 (10) | 352 (11) | 308 (10) | 142 (9) | 57 (7) | 113 (9) | 0.005 |
- Cirrhosis | 677 (7) | 200 (6) | 211 (7) | 122 (8) | 53 (6) | 91 (7) | 0.35 |
eGFR (mL/min/1.73 m2) | 61 ± 37 | 65 ± 36 | 65 ± 37 | 63 ± 38 | 57 ± 39 | 46 ± 34 | <0.001 |
Acute kidney injury | 5283 (54) | 1529 (48) | 1476 (49) | 870 (55) | 470 (58) | 938 (75) | <0.001 |
ICU admission during hospitalization | 4013 (41) | 1192 (37) | 1100 (36) | 652 (41) | 356 (44) | 713 (57) | <0.001 |
Number of serum calcium measurements during hospitalization | 3 (2–5) | 2 (2–3) | 3 (2–4) | 4 (3–7) | 5 (3–9) | 8 (5–14) | <.001 |
Length of hospital stay (day) | 7 (4–14) | 6 (3–11) | 7 (4–12) | 8 (4–16) | 9 (4–21) | 12 (5–27) | <0.001 |
The lowest calcium | 8.3 ± 0.9 | 8.5 ± 0.7 | 8.3 ± 0.7 | 8.1 ± 0.8 | 7.9 ± 1.0 | 7.8 ± 1.3 | <0.001 |
The highest calcium | 9.3 ± 1.3 | 8.8 ± 0.7 | 9.0 ± 0.7 | 9.3 ± 0.8 | 9.6 ± 1.1 | 11.2 ± 2.1 | <0.001 |
The admission calcium | 9.0 ± 1.3 | 8.7 ± 0.7 | 8.8 ± 0.8 | 8.9 ± 0.9 | 9.1 ± 1.2 | 9.9±2.5 | <0.001 |
Outcome | Change in Serum Calcium Level during Hospitalization (mg/dL) | ||||
---|---|---|---|---|---|
0–0.4 | 0.5–0.9 | 1.0–1.4 | 1.5–1.9 | ≥2.0 | |
N | 3200 | 3030 | 1575 | 817 | 1246 |
Hospital mortality | 111 (3.4) | 104 (3.4) | 91 (5.8) | 54 (6.6) | 180 (14.5) |
Mortality, OR (95% CI) | |||||
Model 1: unadjusted | 1 (ref) | 0.99 (0.75–1.30) | 1.71 (1.28–2.27) | 1.97 (1.41–2.75) | 4.70 (3.67–6.01) |
Model 2 # | 1 (ref) | 1.04 (0.78–1.38) | 1.55 (1.45–2.10) | 1.90 (1.32–2.74) | 3.23 (2.39–4.38) |
Model 3: model 2 and lowest calcium | 1 (ref) | 1.07 (0.81–1.43) | 1.65 (1.22–2.24) | 2.04 (1.42–2.94) | 3.52 (2.60–4.78) |
Model 4: model 2 and highest calcium | 1 (ref) | 0.99 (0.74–1.31) | 1.39 (1.02–1.89) | 1.58 (1.09–2.29) | 1.93 (1.34–2.79) |
Model 5: model 2 and admission calcium * | 1 (ref) | 1.02 (0.71–1.47) | 1.32 (0.90–1.94) | 1.76 (1.11–2.79) | 2.50 (1.67–3.74) |
Calcium Change (mg/dL) | N | In-Hospital Mortality | Model 1 | Model 2 | Model 3 | Model 4 | Model 5 * |
---|---|---|---|---|---|---|---|
≤−2.0 | 768 | 66 (8.6) | 2.72 (1.90–3.88) | 2.27 (1.53–3.39) | 2.35 (1.58–3.49) | 1.32 (0.83–2.10) | 1.91 (1.10–3.31) |
−1.9 to −1.5 | 513 | 21 (4.1) | 1.23 (0.75–2.04) | 1.31 (0.77–2.20) | 1.37 (0.81–2.32) | 1.09 (0.64–1.86) | 1.51 (0.83–2.74) |
−1.4 to −1.0 | 961 | 52 (5.4) | 1.65 (1.13–2.41) | 1.58 (1.07–2.34) | 1.65 (1.12–2.45) | 1.42 (0.96–2.10) | 1.42 (0.88–2.29) |
−0.9 to −0.5 | 1764 | 55 (3.1) | 0.93 (0.64–1.34) | 0.96 (0.66–1.40) | 0.98 (0.68–1.43) | 0.91 (0.62–1.32) | 1.06 (0.68–1.66) |
−0.4 to 0.0 | 1885 | 63 (3.3) | 1 (ref) | 1 (ref) | 1 (ref) | 1 (ref) | 1 (ref) |
0.1 to 0.4 | 1316 | 48 (3.7) | 1.09 (0.75–1.60) | 1.05 (0.71–1.55) | 1.07 (0.72–1.58) | 1.06 (0.72–1.57) | 0.95 (0.57–1.60) |
0.5 to 0.9 | 1266 | 49 (3.9) | 1.16 (0.80–1.70) | 1.14 (0.77–1.68) | 1.19 (0.81–1.77) | 1.11 (0.75–1.65) | 0.93 (0.55–1.60) |
1.0 to 1.4 | 614 | 39 (6.4) | 1.96 (1.30–2.96) | 1.93 (1.26–2.96) | 2.10 (1.36–3.23) | 1.82 (1.19–2.80) | 1.79 (1.03–3.11) |
1.5 to 1.9 | 304 | 33 (10.9) | 3.52 (2.27–5.47) | 3.72 (2.33–5.95) | 4.05 (2.52–6.49) | 3.23 (2.01–5.20) | 3.27 (1.74–6.16) |
≥2.0 | 477 | 114 (23.9) | 9.08 (6.54–12.60) | 7.40 (5.08–10.78) | 8.44 (5.74–12.41) | 5.07 (3.36–7.64) | 6.28 (3.82–10.32) |
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Thongprayoon, C.; Cheungpasitporn, W.; Hansrivijit, P.; Medaura, J.; Chewcharat, A.; Mao, M.A.; Bathini, T.; Vallabhajosyula, S.; Thirunavukkarasu, S.; Erickson, S.B. Impact of Changes in Serum Calcium Levels on In-Hospital Mortality. Medicina 2020, 56, 106. https://doi.org/10.3390/medicina56030106
Thongprayoon C, Cheungpasitporn W, Hansrivijit P, Medaura J, Chewcharat A, Mao MA, Bathini T, Vallabhajosyula S, Thirunavukkarasu S, Erickson SB. Impact of Changes in Serum Calcium Levels on In-Hospital Mortality. Medicina. 2020; 56(3):106. https://doi.org/10.3390/medicina56030106
Chicago/Turabian StyleThongprayoon, Charat, Wisit Cheungpasitporn, Panupong Hansrivijit, Juan Medaura, Api Chewcharat, Michael A Mao, Tarun Bathini, Saraschandra Vallabhajosyula, Sorkko Thirunavukkarasu, and Stephen B. Erickson. 2020. "Impact of Changes in Serum Calcium Levels on In-Hospital Mortality" Medicina 56, no. 3: 106. https://doi.org/10.3390/medicina56030106