Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai 200003, China.
Translational Medicine Research Center, Fourth Medical Center and Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing 100048, China.
Biomed Res Int. 2021 Apr 8;2021:6612276. doi: 10.1155/2021/6612276. eCollection 2021.
Although serum calcium has been proven to be a predictor of mortality in a wide range of diseases, its prognostic value in critically ill patients with cardiogenic shock (CS) remains unknown. This retrospective observational study is aimed at investigating the association of admission calcium with mortality among CS patients.
Critically ill patients diagnosed with CS in the Medical Information Mart for Intensive Care-III (MIMIC-III) database were included in our study. The study endpoints included 30-day, 90-day, and 365-day all-cause mortalities. First, admission serum ionized calcium (iCa) and total calcium (tCa) levels were analyzed as continuous variables using restricted cubic spline Cox regression models to evaluate the possible nonlinear relationship between serum calcium and mortality. Second, patients with CS were assigned to four groups according to the quartiles (Q1-Q4) of serum iCa and tCa levels, respectively. In addition, multivariable Cox regression analyses were used to assess the independent association of the quartiles of iCa and tCa with clinical outcomes.
A total of 921 patients hospitalized with CS were enrolled in this study. A nonlinear relationship between serum calcium levels and 30-day mortality was observed (all values for nonlinear trend < 0.001). Furthermore, multivariable Cox analysis showed that compared with the reference quartile (Q3: 1.11 ≤ iCa < 1.17 mmol/L), the lowest serum iCa level quartile (Q1: iCa < 1.04 mmol/L) was independently associated with an increased risk of 30-day mortality (Q1 vs. Q3: HR 1.35, 95% CI 1.00-1.83, = 0.049), 90-day mortality (Q1 vs. Q3: HR 1.36, 95% CI 1.03-1.80, = 0.030), and 365-day mortality (Q1 vs. Q3: HR 1.28, 95% CI 1.01-1.67, = 0.046) in patients with CS.
Lower serum iCa levels on admission were potential predictors of an increased risk of mortality in critically ill patients with CS.
尽管血清钙已被证明可预测多种疾病的死亡率，但在患有心源性休克（CS）的危重病患者中的预后价值尚不清楚。本回顾性观察性研究旨在探讨入院时钙与 CS 患者死亡率之间的关系。
我们的研究纳入了医疗信息集市-III（MIMIC-III）数据库中诊断为 CS 的危重病患者。研究终点包括 30 天、90 天和 365 天全因死亡率。首先，采用受限立方样条 Cox 回归模型分析入院时血清离子钙（iCa）和总钙（tCa）水平作为连续变量，以评估血清钙与死亡率之间可能存在的非线性关系。其次，根据血清 iCa 和 tCa 水平的四分位数（Q1-Q4），将 CS 患者分为四组。此外，还采用多变量 Cox 回归分析评估 iCa 和 tCa 四分位数与临床结局的独立相关性。
本研究共纳入 921 例 CS 住院患者。观察到血清钙水平与 30 天死亡率之间存在非线性关系（所有非线性趋势值均<0.001）。此外，多变量 Cox 分析显示，与参考四分位数（Q3：1.11<iCa<1.17mmol/L）相比，最低血清 iCa 水平四分位数（Q1：iCa<1.04mmol/L）与 30 天死亡率升高独立相关（Q1 比 Q3：HR 1.35，95%CI 1.00-1.83，=0.049）、90 天死亡率（Q1 比 Q3：HR 1.36，95%CI 1.03-1.80，=0.030）和 365 天死亡率（Q1 比 Q3：HR 1.28，95%CI 1.01-1.67，=0.046）。
入院时较低的血清 iCa 水平是 CS 危重病患者死亡率升高的潜在预测因素。
