Department of General Medical, the Affiliated Hospital of Guizhou Medical University, Guiyang, People's Republic of China.
Department of Emergency, Guizhou Provincial People's Hospital, No. 83, Zhongshan East Road, Guiyang, 550002, Guizhou Province, People's Republic of China.
Neurocrit Care. 2019 Feb;30(1):81-87. doi: 10.1007/s12028-018-0574-0.
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.
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.
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).
Admission serum calcium level might be a prognostic marker for intracerebral hemorrhage. Potential mechanism involved calcium-induced coagulation function abnormality.
血清钙水平对脑出血患者预后的意义尚未得到充分研究。本研究旨在确定脑出血患者入院时血清钙水平与预后是否存在关系。
共纳入 1262 例确诊脑出血患者。从病历中收集人口统计学数据、病史、用药史、实验室数据、影像学数据、临床评分和病程记录。所有头颅 CT 图像均重新分析。记录 90 天预后，脑出血导致的死亡或重度残疾定义为不良预后。
在 90 天随访期间，504 例患者死亡，226 例患者发生重度残疾。死亡和重度残疾合并为不良预后。其余 532 例患者预后良好。不良预后患者的入院血清钙水平低于预后良好的患者（2.41±0.23mmol/L，2.55±0.26mmol/L，P<0.001）。不良预后患者的入院 INR 和血肿体积均高于预后良好的患者（INR：1.74±0.29，1.70±0.29，P=0.029；血肿体积：11.6±4.4ml，10.7±4.1ml，P<0.001）。两组预后患者的入院 APTT 水平无差异（28.4±5.6s，27.8±5.4s，P=0.056）。多因素 COX 回归分析显示，入院时血清钙水平≤2.41mmol/L与脑出血患者不良预后（死亡或重度残疾）的风险增加相关（HR 1.45，95%CI 1.32-1.60）。此外，入院时血清钙水平与凝血功能标志物和血肿体积呈显著线性相关（APTT：r=-0.091，P=0.001；INR：r=-0.063，P=0.025；血肿体积：r=-0.108，P<0.001）。
入院血清钙水平可能是脑出血的预后标志物。潜在机制涉及钙诱导的凝血功能异常。
