Mao Yafei, Zhu Shumin, Geng Yulan
Department of Laboratory Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
Hematology. 2022 Dec;27(1):795-801. doi: 10.1080/16078454.2022.2095948.
Elevated serum calcium levels may serve as a useful clinical biomarker of mortality in patients with multiple myeloma(MM). However, the clinical significance of the relationship between serum calcium levels and in-hospital mortality in MM patients admitted to the Intensive Care Unit (ICU) remains unclear.
This study aimed to explore the association between serum calcium levels and in-hospital mortality in patients with MM in the ICU.
Patients with MM were identified from the Medical Information Mart for Intensive Care IV(MIMIC-IV) database. The outcome was in-hospital mortality. Multivariable-adjusted Cox regression analysis, curve fitting, and threshold effects analysis were used to assess the relationship between serum calcium levels and in-hospital mortality in patients with MM in the ICU.
Our study included 262 patients with MM with a mean age of 72.3 ± 11.0 years, 63.4% of whom were male. The in-hospital mortality was 19.5% (51/262). The relationship between serum calcium levels and in-hospital mortality was nonlinear. The effect size on the left and right sides of the inflection point, were 0.270 (HR: 0.270, 95% CI 0.106-0.687, 0.05) and 2.104 (HR: 2.104, 95% CI 1.069-4.142, < 0.05), respectively. The results of the sensitivity analysis remained stable.
Our findings show that a nonlinear relationship exists between serum calcium levels and in-hospital mortality in critically ill patients with MM. A serum calcium level of approximately 8.40 mg/dL was associated with the lowest risk of in-hospital mortality, which increases with rising serum calcium levels, and should be of concern to ICU physicians.
血清钙水平升高可能是多发性骨髓瘤（MM）患者死亡率的一个有用的临床生物标志物。然而，血清钙水平与入住重症监护病房（ICU）的MM患者院内死亡率之间关系的临床意义仍不清楚。
本研究旨在探讨ICU中MM患者血清钙水平与院内死亡率之间的关联。
从重症监护医学信息集市IV（MIMIC-IV）数据库中识别出MM患者。结局指标为院内死亡率。采用多变量调整的Cox回归分析、曲线拟合和阈值效应分析来评估ICU中MM患者血清钙水平与院内死亡率之间的关系。
我们的研究纳入了262例MM患者，平均年龄为72.3±11.0岁，其中63.4%为男性。院内死亡率为19.5%（51/262）。血清钙水平与院内死亡率之间的关系是非线性的。拐点左右两侧的效应大小分别为0.270（HR：0.270，95%CI 0.106-0.687，P<0.05）和2.104（HR：2.104，95%CI 1.069-4.142，P<0.05）。敏感性分析结果保持稳定。
我们的研究结果表明，重症MM患者血清钙水平与院内死亡率之间存在非线性关系。血清钙水平约为8.40mg/dL时，院内死亡风险最低，随着血清钙水平升高，死亡风险增加，这应引起ICU医生的关注。
