Can baseline serum calcium levels predict outcomes of intracerebral hemorrhage? A systematic review and meta-analysis.

OBJECTIVE

The prognostic role of baseline calcium levels in patients with intracerebral hemorrhage (ICH) is conflicting. We aimed to conduct the first meta-analysis in the literature to examine if baseline calcium levels can predict outcomes after ICH.

METHODS

English-language studies listed on the databases of Embase, PubMed, ScienceDirect, and Web of Science were searched up to 20th November 2023. Meta-analysis was conducted for baseline hematoma volume, hematoma expansion, unfavorable functional outcome, and mortality.

RESULTS

Ten studies were included. Meta-analysis showed that patients with hypocalcemia have significantly higher baseline hematoma volume (MD: 8.6 95 % CI: 3.30, 13.90 I = 88 %) but did not have a higher risk of hematoma expansion (OR: 1.82 95 % CI: 0.89, 3.73 I = 82 %). Meta-analysis of crude (OR: 1.86 95 % CI: 1.25, 2.78 I = 63 %) and adjusted data (OR: 2.05 95 % CI: 1.27, 3.28 I = 64 %) showed those with hypocalcemia had a significantly higher risk of unfavorable functional outcomes. Meta-analysis of both crude (OR: 2.09 95 % CI: 1.51, 2.88 I = 80 %) and adjusted data (OR: 1.38 95 % CI: 1.14, 1.69 I = 70 %) also demonstrated a significantly higher risk of mortality in patients with hypocalcemia.

CONCLUSION

Baseline serum calcium may have a prognostic role in ICH. Hypocalcemia at baseline may lead to large hematoma volume and poor functional and survival outcomes. However, there seems to be no relation between hypocalcemia and the risk of hematoma expansion. Further studies examining the role of calcium on ICH prognosis are needed.