Shirakabe Akihiro, Kiuchi Kazutaka, Kobayashi Nobuaki, Okazaki Hirotake, Matsushita Masato, Shibata Yusaku, Shigihara Shota, Sawatani Tomofumi, Tani Kenichi, Otsuka Yusuke, Asai Kuniya, Shimizu Wataru
Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital Chiba Japan.
Department of Cardiovascular Medicine, Nippon Medical School Tokyo Japan.
Circ Rep. 2020 Dec 23;3(1):44-54. doi: 10.1253/circrep.CR-20-0068.
Serum calcium (Ca) concentrations in the acute phase of acute heart failure (AHF) have not been not sufficiently investigated. This study enrolled 1,291 AHF patients and divided them into 3 groups based on original and corrected Ca concentrations: (1) hypocalcemia (both original and corrected Ca ≤8.7 mg/dL; n=651); (2) pseudo-hypocalcemia (original and corrected Ca ≤8.7 and >8.7 mg/dL, respectively; n=300); and (3) normal/hypercalcemia (both original and corrected Ca >8.7 mg/dL; n=340). AHF patients were also divided into 2 groups based on corrected Ca concentrations: (1) corrected hypocalcemia (corrected Ca ≤8.7 mg/dL; n=651); and (2) corrected normal/hypercalcemia (corrected Ca >8.7 mg/dL; n=640). Of the 951 patients with original hypocalcemia (≤8.7 mg/dL), 300 (31.5%) were classified as corrected normal/hypercalcemia after correction of Ca concentrations by serum albumin. The prognoses in the pseudo-hypocalcemia, low albumin, and corrected normal/hypercalcemia groups, including all-cause death within 730 days, were significantly poorer than in the other groups. Multivariate Cox regression analysis showed that classification into the pseudo-hypocalcemia, hypoalbumin, and corrected normal/hypercalcemia groups independently predicted 730-day all-cause death (hazard ratios [95% confidence intervals] of 1.497 [1.153-1.943], 2.392 [1.664-3.437], and 1.294 [1.009-1.659], respectively). Corrected normal/hypercalcemia was an independent predictor of prognosis because this group included patients with pseudo-hypocalcemia, which was affected by the serum albumin concentration.
急性心力衰竭（AHF）急性期的血清钙（Ca）浓度尚未得到充分研究。本研究纳入了1291例AHF患者，并根据初始和校正后的Ca浓度将他们分为3组：（1）低钙血症（初始和校正后的Ca均≤8.7mg/dL；n = 651）；（2）假性低钙血症（初始和校正后的Ca分别≤8.7和>8.7mg/dL；n = 300）；以及（3）正常/高钙血症（初始和校正后的Ca均>8.7mg/dL；n = 340）。AHF患者也根据校正后的Ca浓度分为2组：（1）校正后低钙血症（校正后的Ca≤8.7mg/dL；n = 651）；以及（2）校正后正常/高钙血症（校正后的Ca>8.7mg/dL；n = 640）。在951例初始低钙血症（≤8.7mg/dL）患者中，300例（31.5%）在通过血清白蛋白校正Ca浓度后被分类为校正后正常/高钙血症。假性低钙血症、低白蛋白血症和校正后正常/高钙血症组的预后，包括730天内的全因死亡，明显比其他组差。多变量Cox回归分析表明，分类为假性低钙血症、低白蛋白血症和校正后正常/高钙血症组独立预测730天全因死亡（风险比[95%置信区间]分别为1.497[1.153 - 1.943]、2.392[1.664 - 3.437]和1.294[1.009 - 1.659]）。校正后正常/高钙血症是预后的独立预测因素，因为该组包括受血清白蛋白浓度影响的假性低钙血症患者。
