Zhang Jiarui, Ali Adila, Liu Yu, Peng Lige, Pu Jiaqi, Yi Qun, Zhou Haixia
Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Cancer Hospital Affiliate to School of Medicine, Sichuan Cancer Hospital and Institution, Sichuan Cancer Center, UESTC, Sichuan Province, Chengdu, China.
Thromb J. 2023 Feb 15;21(1):20. doi: 10.1186/s12959-023-00461-y.
Hypocalcemia has been shown to be involved in the adverse outcomes of acute pulmonary embolism (APE). We aimed to determine the incremental value of adding hypocalcemia, defined as serum calcium level ≤ 2.12 mmol/L, on top of the European Society of Cardiology (ESC) prognostic algorithm, for the prediction of in-hospital mortality in APE patients, which in turn could lead to the optimization of APE management.
This study was conducted at West China Hospital of Sichuan University from January 2016 to December 2019. Patients with APE were retrospectively analyzed and divided into 2 groups based on serum calcium levels. Associations between hypocalcemia and adverse outcomes were assessed by Cox analysis. The accuracy of risk stratification for in-hospital mortality was assessed with the addition of serum calcium to the current ESC prognostic algorithm.
Among 803 patients diagnosed with APE, 338 (42.1%) patients had serum calcium levels ≤ 2.12 mmol/L. Hypocalcemia was significantly associated with higher in-hospital and 2-year all-cause mortality compared to the control group. The addition of serum calcium to ESC risk stratification enhanced net reclassification improvement. Low-risk group with serum calcium level > 2.12 mmol/L had a 0% mortality rate, improving the negative predictive value up to 100%, while high-risk group with serum calcium level ≤ 2.12 mmol/L indicated a higher mortality of 25%.
Our study identified serum calcium as a novel predictor of mortality in patients with APE. In the future, serum calcium may be added to the commonly used ESC prognostic algorithm for better risk stratification of patients suffering from APE.
低钙血症已被证明与急性肺栓塞（APE）的不良结局有关。我们旨在确定在欧洲心脏病学会（ESC）预后算法基础上，添加定义为血清钙水平≤2.12 mmol/L的低钙血症因素，对于预测APE患者院内死亡率的增量价值，这反过来可能会优化APE的管理。
本研究于2016年1月至2019年12月在四川大学华西医院进行。对APE患者进行回顾性分析，并根据血清钙水平分为两组。通过Cox分析评估低钙血症与不良结局之间的关联。在当前ESC预后算法中加入血清钙，评估院内死亡率风险分层的准确性。
在803例诊断为APE的患者中，338例（42.1%）患者血清钙水平≤2.12 mmol/L。与对照组相比，低钙血症与更高的院内死亡率和2年全因死亡率显著相关。在ESC风险分层中加入血清钙可提高净重新分类改善。血清钙水平>2.12 mmol/L的低风险组死亡率为0%，将阴性预测值提高到100%，而血清钙水平≤2.12 mmol/L的高风险组死亡率为25%。
我们的研究确定血清钙是APE患者死亡率的一个新的预测指标。未来，血清钙可能会被添加到常用的ESC预后算法中，以便对APE患者进行更好的风险分层。
