Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Eur Surg Res. 2023;64(4):398-405. doi: 10.1159/000534522. Epub 2023 Oct 9.
Calcium is an essential co-factor in the coagulation cascade, and hypocalcemia is associated with adverse outcomes in bleeding patients, including trauma patients, women with postpartum hemorrhage, and patients with intracranial hemorrhage. In this retrospective, single-center, cohort study, we aimed to determine whether admission-ionized calcium (Ca++) is associated with higher rates of therapeutic interventions among patients presenting with acute nonvariceal upper gastrointestinal bleeding (NV-UGIB).
Adult patients admitted due to NV-UGIB between January 2009 and April 2020 were identified. The primary outcome was defined as a need for clinical intervention (two or more packed cell transfusions, need for endoscopic, surgical, or angiographic intervention). Univariate and multivariable logistic regression analyses were performed to determine whether Ca++ was an independent predictor of the need for therapeutic interventions. Propensity score matching was performed to adjust the imbalances of covariates between the groups.
A total of 434 patients were included, of whom 148 (34.1%) had hypocalcemia (Ca++ <1.15 mmol/L). Patients with hypocalcemia were more likely to require therapeutic interventions than those without hypocalcemia (48.0% vs. 18.5%, p < 0.001). Specifically, patients with hypocalcemia were more likely to require endoscopic intervention for control of bleeding (25.0% vs. 15.7%, p = 0.03) and multiple packed cell transfusions (6.8% vs. 0.3%, p < 0.001). Additionally, they had significantly longer hospital stay (5.0 days [IQR 3.0-8.0] vs. 4.0 days [IQR 3.0-6.0], p = 0.01). After adjusting for multiple covariates, Ca++ was an independent predictor of the need for therapeutic intervention (aOR 1.62, 95% confidence interval [CI] 1.22-2.14, p < 0.001). The addition of Ca++ to the Modified Glasgow Blatchford score improved its accuracy in the prediction of therapeutic intervention from AUC of 0.68 (95% CI 0.63-0.72) to 0.72 (95% CI 0.67-0.76), p = 0.02. After incorporation of the propensity score, the results did not change significantly.
These findings suggest that hypocalcemia is common and is associated with an adverse clinical course in patients with NV-UGIB. Measurement of Ca++ on admission may facilitate risk stratification in these patients. Trials are needed to assess whether the correction of hypocalcemia will lead to improved outcomes.
钙是凝血级联反应的必需辅助因子，低钙血症与出血患者的不良结局相关，包括创伤患者、产后出血的女性和颅内出血的患者。在这项回顾性、单中心队列研究中，我们旨在确定入院时离子钙（Ca++）是否与急性非静脉曲张性上消化道出血（NV-UGIB）患者接受更高治疗干预的发生率有关。
确定 2009 年 1 月至 2020 年 4 月因 NV-UGIB 入院的成年患者。主要结局定义为需要临床干预（两次或更多袋细胞输注、需要内镜、手术或血管造影干预）。进行单变量和多变量逻辑回归分析，以确定 Ca++是否是治疗干预需要的独立预测因素。进行倾向评分匹配以调整组间混杂因素的不平衡。
共纳入 434 例患者，其中 148 例（34.1%）存在低钙血症（Ca++<1.15mmol/L）。低钙血症患者比无低钙血症患者更需要治疗干预（48.0%比 18.5%，p < 0.001）。具体而言，低钙血症患者更有可能需要内镜干预来控制出血（25.0%比 15.7%，p = 0.03）和多次袋细胞输注（6.8%比 0.3%，p < 0.001）。此外，他们的住院时间明显更长（5.0 天 [IQR 3.0-8.0] 比 4.0 天 [IQR 3.0-6.0]，p = 0.01）。在校正多个混杂因素后，Ca++是治疗干预需要的独立预测因素（优势比 1.62，95%置信区间 [CI] 1.22-2.14，p < 0.001）。将 Ca++添加到改良格拉斯哥出血评分中，提高了其预测治疗干预的准确性，从 AUC 为 0.68（95%CI 0.63-0.72）提高到 0.72（95%CI 0.67-0.76），p = 0.02。在纳入倾向评分后，结果没有显著变化。
这些发现表明，低钙血症在 NV-UGIB 患者中很常见，与不良临床病程相关。入院时测量 Ca++可能有助于对这些患者进行风险分层。需要评估纠正低钙血症是否会改善结局。
