Admission Serum Calcium Level As a Prognostic Marker for Intracerebral Hemorrhage

Overview

Journal Neurocrit Care

Specialty Critical Care

Date 2018 Jul 12

PMID 29995185

Citations 14

Authors

Li Tu

Xiujuan Liu

Tian Li

Xiulin Yang

Yipin Ren

Qian Zhang

Huan Yao

Xiang Qu

Qian Wang

Tian Tian

Jinyong Tian

Affiliations

Soon will be listed here.

Abstract

Background: Prognostic significance of serum calcium level in patients with intracerebral hemorrhage is not well studied. The aim of the study was to identify if a relationship between admission serum calcium level and prognosis exists in patients with intracerebral hemorrhage.

Methods: A total of 1262 confirmed intracerebral hemorrhage patients were included. Demographic data, medical history, medicine history, laboratory data, imaging data, clinical score, and progress note were collected from their medical records. All images of head computed tomography were reanalyzed. Ninety-day prognosis was recorded, and poor outcome was defined as death or major disability caused by intracerebral hemorrhage.

Results: During the 90-day follow-up period, 504 patients died and 226 patients suffered from major disability. Death and major disability were combined as poor prognosis. The remaining 532 patients showed good prognosis. Admission serum calcium level was lower in the patients with poor prognosis than in the patients with good prognosis (2.41 ± 0.23 mmol/l, 2.55 ± 0.26 mmol/l, P < 0.001). Admission INR and hematoma volume were higher in the patients with poor prognosis than in the patients with good prognosis (INR: 1.74 ± 0.29, 1.70 ± 0.29, P = 0.029; hematoma volume: 11.6 ± 4.4 ml, 10.7 ± 4.1 ml, P < 0.001). There was no difference in admission APTT level between the two prognosis groups (28.4 ± 5.6 s, 27.8 ± 5.4 s, P = 0.056). A multivariate COX regression analysis reported that admission serum calcium level ≤ 2.41 mmol/l was associated with the increased risk of poor prognosis (death or major disability) in the patients (HR 1.45, 95% CI 1.32-1.60). In addition, there was a significant linear association of serum calcium level with coagulation function markers and hematoma volume on admission (APTT: r = - 0.091, P = 0.001; INR: r = - 0.063, P = 0.025; hematoma volume: r = -0.108, P < 0.001).

Conclusions: Admission serum calcium level might be a prognostic marker for intracerebral hemorrhage. Potential mechanism involved calcium-induced coagulation function abnormality.

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References

Keep R, Hua Y, Xi G . Intracerebral haemorrhage: mechanisms of injury and therapeutic targets. Lancet Neurol. 2012; 11(8):720-31. PMC: 3884550. DOI: 10.1016/S1474-4422(12)70104-7. View

Navi B, Parikh N, Lerario M, Merkler A, Lappin R, Fahimi J . Risk of Intracerebral Hemorrhage after Emergency Department Discharges for Hypertension. J Stroke Cerebrovasc Dis. 2016; 25(7):1683-1687. PMC: 4912410. DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.046. View

Rojo Martinez E, Guerrero Peral A, Herrero Velazquez S, Nunez Garcia J . Recurrent intracerebral haemorrhage in primary amyloidosis. Neurologia. 2011; 28(4):252-5. DOI: 10.1016/j.nrl.2011.10.006. View

Dowlatshahi D, Demchuk A, Flaherty M, Ali M, Lyden P, Smith E . Defining hematoma expansion in intracerebral hemorrhage: relationship with patient outcomes. Neurology. 2011; 76(14):1238-44. PMC: 3068004. DOI: 10.1212/WNL.0b013e3182143317. View

Inoue Y, Miyashita F, Toyoda K, Minematsu K . Low serum calcium levels contribute to larger hematoma volume in acute intracerebral hemorrhage. Stroke. 2013; 44(7):2004-6. DOI: 10.1161/STROKEAHA.113.001187. View

Guo Y, Yan S, Zhang S, Zhang X, Chen Q, Liu K . Lower serum calcium level is associated with hemorrhagic transformation after thrombolysis. Stroke. 2015; 46(5):1359-1361. PMC: 4414875. DOI: 10.1161/STROKEAHA.115.008992. View

Morotti A, Charidimou A, Phuah C, Jessel M, Schwab K, Ayres A . Association Between Serum Calcium Level and Extent of Bleeding in Patients With Intracerebral Hemorrhage. JAMA Neurol. 2016; 73(11):1285-1290. PMC: 5287716. DOI: 10.1001/jamaneurol.2016.2252. View

Jackson S, Nesbitt W, Kulkarni S . Signaling events underlying thrombus formation. J Thromb Haemost. 2003; 1(7):1602-12. DOI: 10.1046/j.1538-7836.2003.00267.x. View

Triplett D . Coagulation and bleeding disorders: review and update. Clin Chem. 2000; 46(8 Pt 2):1260-9. View

10.

Mupanomunda M, Ishioka N, Bukoski R . Interstitial Ca2+ undergoes dynamic changes sufficient to stimulate nerve-dependent Ca2+-induced relaxation. Am J Physiol. 1999; 276(3):H1035-42. DOI: 10.1152/ajpheart.1999.276.3.H1035. View

11.

Ohwaki K, Yano E, Nagashima H, Hirata M, Nakagomi T, Tamura A . Blood pressure management in acute intracerebral hemorrhage: relationship between elevated blood pressure and hematoma enlargement. Stroke. 2004; 35(6):1364-7. DOI: 10.1161/01.STR.0000128795.38283.4b. View

12.

Barlow P . A practical review of the Glasgow Coma Scale and Score. Surgeon. 2012; 10(2):114-9. DOI: 10.1016/j.surge.2011.12.003. View

13.

Odderson I . The National Institutes of Health Stroke Scale and its importance in acute stroke management. Phys Med Rehabil Clin N Am. 1999; 10(4):787-800, vii. View

14.

Quinn T, Dawson J, Walters M, Lees K . Reliability of the modified Rankin Scale: a systematic review. Stroke. 2009; 40(10):3393-5. DOI: 10.1161/STROKEAHA.109.557256. View

15.

Wellman G, Nathan D, Saundry C, Perez G, Bonev A, Penar P . Ca2+ sparks and their function in human cerebral arteries. Stroke. 2002; 33(3):802-8. DOI: 10.1161/hs0302.104089. View

16.

Llach F, Weidmann P, REINHART R, Maxwell M, Coburn J, Massry S . Effect of acute and long-standing hypocalcemia on blood pressure and plasma renin activity in man. J Clin Endocrinol Metab. 1974; 38(5):841-7. DOI: 10.1210/jcem-38-5-841. View

17.

Johari V, Loke C . Brief overview of the coagulation cascade. Dis Mon. 2012; 58(8):421-3. DOI: 10.1016/j.disamonth.2012.04.004. View

18.

Borah M, Dhar S, Gogoi D, Ruram A . Association of Serum Calcium Levels with Infarct Size in Acute Ischemic Stroke: Observations from Northeast India. J Neurosci Rural Pract. 2017; 7(Suppl 1):S41-S45. PMC: 5244059. DOI: 10.4103/0976-3147.196461. View