J Sachinkumar, Hegde Swathi
ESI Medical College and Post Graduate Institute of Medical Science and Research, Bengaluru, Karnataka, India.
J Assoc Physicians India. 2023 Jan;71(1):1.
Calcium is one of the most important electrolytes of human body and regulators of cell events, such as signaling, hormone secretion, glycogen metabolism, and cell mitosis. Extracellular calcium not only is a source for intracellular calcium but also has an important role in the maintenance and stability of cell wall and clot formation (1). The wide range in the concentration of total calcium may be related to changes in albumin concentration or any change in hydration in patients. Considering the important role of calcium in the human body, the high prevalence of hypocalcaemia in ICU patients, and the low number of studies assessing the correlation between serum calcium with ICU outcomes, we decided to determine the relationship between total calcium concentrations and disease severity in critically ill patients (2).
A total of 100 patients admitted to intensive care units of Esi Medical college, Bangalore during Jan 2021 and june 2022 were enrolled in this cross sectional study. Total calcium on the day of admission and their relationship with APACHE score and disease severity were noted during the study.
A total of 100 patients were enrolled, among them 58% were males and 42% were females. The mean age of the study participants were 66.3 years. There was significant difference of mean Arterial pH score, Apache Score, Serum Mg+ and serum Ca+ between the patients with GCS Score <8 (comatose) and patients with GCS = 8 (Non-Comatose). There was significant correlation (r = -0.599) between the Apache Score and GCS score. Also, Apache score was related to the Serum Mg+ (-0.422) and Serum Ca+ (-0.541). There was a medium and a statistically significant inverse relationship between disease severity and total calcium and magnesium concentration (P < 0.001).
A significant correlation was found between total calcium and disease severity. Hypocalcemia is a predictor of disease severity and mortality. We recommend measuring ionized calcium concentration for patients admitted to ICU. References Calvi LM, Bushinsky DA. When is it appropriate to order an ionized calcium? J Am Soc Nephrol. 2008;19(7):1257-1256 Sanaie S, Mahmoodpoor A, Hamishehkar H, et al. Association between disease severity and calcium concentration in critically ill patients admitted to intensive care unit. Anesth Pain Med. 2018;8(1):e57583. Kelly A, Levine MA. Hypocalcemia in the critically ill patient. J Intensive Care Med 2013;28(3):166-77.
钙是人体最重要的电解质之一，也是细胞活动的调节因子，如信号传导、激素分泌、糖原代谢和细胞有丝分裂。细胞外钙不仅是细胞内钙的来源，而且在维持细胞壁的稳定性和凝血形成中起重要作用(1)。总钙浓度的广泛变化可能与患者白蛋白浓度的变化或任何水合作用的变化有关。考虑到钙在人体中的重要作用、重症监护病房（ICU）患者中低钙血症的高患病率以及评估血清钙与ICU预后之间相关性的研究数量较少，我们决定确定危重症患者总钙浓度与疾病严重程度之间的关系(2)。
本横断面研究纳入了2021年1月至2022年6月期间入住班加罗尔ESI医学院重症监护病房的100例患者。在研究期间记录入院当天的总钙及其与急性生理与慢性健康状况评分系统（APACHE）评分和疾病严重程度的关系。
共纳入100例患者，其中男性占58%，女性占42%。研究参与者的平均年龄为66.3岁。格拉斯哥昏迷评分（GCS）<8（昏迷）的患者与GCS = 8（非昏迷）的患者之间，平均动脉pH值评分、APACHE评分、血清镁离子和血清钙离子存在显著差异。APACHE评分与GCS评分之间存在显著相关性（r = -0.599）。此外，APACHE评分与血清镁离子（-0.422）和血清钙离子（-0.541）相关。疾病严重程度与总钙和镁浓度之间存在中等程度且具有统计学意义的负相关关系（P < 0.001）。
发现总钙与疾病严重程度之间存在显著相关性。低钙血症是疾病严重程度和死亡率的预测指标。我们建议对入住ICU的患者测量离子钙浓度。参考文献：Calvi LM, Bushinsky DA.何时适合检测离子钙？《美国肾脏病学会杂志》。2008;19(7):1257-1256 Sanaie S, Mahmoodpoor A, Hamishehkar H等。入住重症监护病房的危重症患者疾病严重程度与钙浓度之间的关联。《麻醉与疼痛医学》。2018;8(1):e57583。Kelly A, Levine MA.危重症患者的低钙血症。《重症监护医学杂志》2013;28(3):166-77。
