Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
Atherosclerosis. 2021 May;325:24-29. doi: 10.1016/j.atherosclerosis.2021.03.030. Epub 2021 Mar 29.
Serum calcium abnormality is associated with adverse cardiovascular outcomes, but the effects of serum calcium level on stroke outcomes remain unknown. We aimed to assess the relationship between serum calcium level and 1-year outcomes in patients with acute ischemic stroke and transient ischemic attack.
We included 9375 stroke patients from the China National Stroke Registry III for analysis. Participants were divided into 4 groups according to albumin corrected-calcium quartiles. Composite end point comprised recurrent stroke, myocardial infarction, other ischemic vascular events, and all-cause mortality. Multivariable Cox or logistic regression was used to evaluate the independent association of albumin corrected-calcium with all-cause mortality, recurrent stroke, composite end point, and poor functional outcome (modified Rankin Scale score ≥3).
Compared with the lowest calcium quartile (<2.16 mmol/L), the adjusted hazard ratio (95% CI) of the top quartile (≥2.31 mmol/L) was 1.56 (1.11-2.18) for all-cause mortality, 1.06 (0.87-1.28) for recurrent stroke and 1.08 (0.90-1.01) for composite end point, and the adjusted odds ratio for poor functional outcome was 1.18 (0.96-1.44). The addition of serum calcium to conventional risk factors improved risk prediction of all-cause mortality, leading to a small but significant increase in C-statistics and reclassification with non-significant integrated discrimination improvement (C-statistics, p = 0.02; net reclassification index 11.8%, p = 0.038; integrated discrimination improvement 0.08%, p = 0.42).
High serum calcium levels at baseline were associated with all-cause mortality at 1-year after ischemic stroke, suggesting that serum calcium may be a potential prognostic biomarker and therapeutic target for ischemic stroke.
血清钙异常与不良心血管结局相关，但血清钙水平对卒中结局的影响尚不清楚。本研究旨在评估急性缺血性卒中和短暂性脑缺血发作患者的血清钙水平与 1 年结局的关系。
我们对中国国家卒中登记研究 III 中的 9375 例卒中患者进行了分析。根据白蛋白校正钙四分位数，将参与者分为 4 组。复合终点包括复发性卒中、心肌梗死、其他缺血性血管事件和全因死亡率。多变量 Cox 或逻辑回归用于评估白蛋白校正钙与全因死亡率、复发性卒中、复合终点和不良功能结局（改良 Rankin 量表评分≥3）的独立相关性。
与最低钙四分位数（<2.16 mmol/L）相比，最高钙四分位数（≥2.31 mmol/L）的校正后危险比（95%可信区间）为全因死亡率的 1.56（1.112.18），复发性卒中的 1.06（0.871.28），复合终点的 1.08（0.901.01），不良功能结局的校正优势比为 1.18（0.961.44）。将血清钙纳入常规危险因素可改善全因死亡率的风险预测，导致 C 统计量略有但显著增加，且重新分类的综合判别改善无显著差异（C 统计量，p=0.02；净重新分类指数 11.8%，p=0.038；综合判别改善 0.08%，p=0.42）。
基线时高血清钙水平与缺血性卒中后 1 年的全因死亡率相关，提示血清钙可能是缺血性卒中的一个潜在预后生物标志物和治疗靶点。
