Shmuel A. Appela, Noa Molshatzkia, Yvonne Schwammenthala, Oleg Merzeliaka, Maya Toashia, Ben-Ami Selab, c, David Tannea, c
aStroke Center, Department of Neurology, and
bInstitute of Chemical Pathology, The Chaim Sheba Medical Center, Tel Hashomer, and
cSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Prof. David Tanne; Stroke Center, Department of Neurology; The Chaim Sheba Medical Center; tanne at post.tau.ac.il
Cerebrovasc Dis 2011;31:93-99 (DOI: 10.1159/000321335)
Background: Calcium concentrations in serum are maintained within an exquisitely narrow range. Our aim was to examine the association between serum calcium and albumin-adjusted calcium (calciumadj) levels and stroke outcome in a cohort of unselected patients with acute stroke.
Methods: Consecutive patients hospitalized due to acute stroke (ischemic or intracerebral hemorrhage) throughout a large medical center were systematically assessed and followed for 1 year. Baseline total calcium and calciumadj levels were collapsed into groups of low (<8.6 mg/dl), normal (8.7–9.9 mg/dl) and high (>10 mg/dl) levels and linear and quadratic relations with outcome were examined.
Result: Among 784 patients (mean age 70.7 ± 12.5 years, 42.5% females), the mean ± SD total calcium level was 9.3 ± 0.6 mg/dl.
For total calcium, the adjusted hazard ratio (HR) for all-cause death over 1 year was 1.83 95% confidence interval (CI) 1.22–2.75 among patients with low versus normal levels. For calciumadj, the adjusted HR for all-cause death among women was over 3-fold higher among patients with high calciumadj levels versus those with normal levels (3.31; 95% CI 1.70–6.46), while no such associations were observed among men. In models developed to estimate the linear and quadratic relations, each unit increment in total calcium squared was associated with an increased adjusted HR of all-cause death over 1 year (p = 0.02) confirming nonlinear associations, and each unit increment in calciumadj squared was associated with an increased adjusted HR of all-cause death over 1 year among women (p < 0.001) but not among men (p = 0.70).
Conclusions: Serum calcium concentrations are a marker of mortality in acute stroke patients, but the associations are not linear, increasing at both extremes of calcium levels. Our findings suggest that long-term survival is optimal in a distinct range of serum calcium levels.
Copyright © 2010 S. Karger AG, Basel
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