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Zhang K, Zhang T, Lv QY, Han Y, Cai T, Gu FM, Gu ZX, Zhao JY, Liang JY, Gao M, Gao YF, Hu R, Cui D, Li B, Liu K. U-shaped association between serum calcium and in-hospital mortality in diabetes patients with congestive heart failure: a cohort study. Sci Rep 2024; 14:13412. [PMID: 38862553 PMCID: PMC11167038 DOI: 10.1038/s41598-024-63603-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/30/2024] [Indexed: 06/13/2024] Open
Abstract
Previous studies have reported that the significant association between serum calcium and mortality substantially in patients, especially among those with intensive care unit (ICU). And In diabetes mellitus, congestive heart failure (CHF) is a significant comorbidity. We aim to evaluate the association between serum calcium levels and in-hospital mortality among patients with diabetes and congestive heart failure. The participants in this study were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. To scrutinize potential associations between serum calcium levels and in-hospital mortality, a comprehensive analysis encompassing multivariate logistic regression, cubic spline function model, threshold effect analysis, and subgroup analysis was performed. This retrospective cohort study encompassed 7063 patients, among whom the in-hospital mortality stood at 12.2%. In the multivariate logistic regression, adjusted odds ratios (ORs) were contrasted with the reference category Q6 (8.8-9.1 mg/dL) for serum calcium levels and in-hospital mortality. The adjusted ORs for Q1 (≤ 7.7 mg/dL), Q2 (7.7-8 mg/dL), and Q7 (≥ 9.1 mg/dL) were 1.69 (95% CI 1.17-2.44, p = 0.005), 1.62 (95% CI 1.11-2.36, p = 0.013), and 1.57 (95% CI 1.1-2.24, p = 0.012) respectively. The dose-response analysis uncovered a U-shaped relationship between serum calcium levels and in-hospital mortality in diabetic patients with heart failure. Subgroup analyses confirmed result stability notwithstanding the influence of diverse factors. Our investigation revealed a U-shaped correlation between serum calcium levels and in-hospital mortality in diabetes patients with congestive heart failure, pinpointing a significant inflection point at 9.05 mg/dL.
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Affiliation(s)
- Kai Zhang
- Cardiovascular Surgery Department of Jilin University Second Hospital, No. 218, Ziqiang Street, Changchun, Jilin Province, China.
| | - Tianqi Zhang
- Cardiovascular Surgery Department of Jilin University Second Hospital, No. 218, Ziqiang Street, Changchun, Jilin Province, China
| | - Qian Yu Lv
- Cardiovascular Surgery Department of Jilin University Second Hospital, No. 218, Ziqiang Street, Changchun, Jilin Province, China
| | - Yu Han
- Department of Ophthalmology, First Hospital of Jilin University, Changchun, China
| | - Tianyi Cai
- Department of Ophthalmology, Second Hospital of Jilin University, Changchun, China
| | - Fang Ming Gu
- Cardiovascular Surgery Department of Jilin University Second Hospital, No. 218, Ziqiang Street, Changchun, Jilin Province, China
| | - Zhao Xuan Gu
- Cardiovascular Surgery Department of Jilin University Second Hospital, No. 218, Ziqiang Street, Changchun, Jilin Province, China
| | - Jia Yu Zhao
- Cardiovascular Surgery Department of Jilin University Second Hospital, No. 218, Ziqiang Street, Changchun, Jilin Province, China
| | - Jia Ying Liang
- Cardiovascular Surgery Department of Jilin University Second Hospital, No. 218, Ziqiang Street, Changchun, Jilin Province, China
| | - Min Gao
- Department of Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Ya Fang Gao
- Department of Ophthalmology, Second Hospital of Jilin University, Changchun, China
| | - Rui Hu
- Department of Ophthalmology, Second Hospital of Jilin University, Changchun, China
| | - Dan Cui
- Cardiovascular Surgery Department of Jilin University Second Hospital, No. 218, Ziqiang Street, Changchun, Jilin Province, China
| | - Bo Li
- Cardiovascular Surgery Department of Jilin University Second Hospital, No. 218, Ziqiang Street, Changchun, Jilin Province, China
| | - Kexiang Liu
- Cardiovascular Surgery Department of Jilin University Second Hospital, No. 218, Ziqiang Street, Changchun, Jilin Province, China.
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Zhang XQ, Shen JH, Zhou Q, Duan XJ, Guo YF. Red cell distribution width to total serum calcium ratio and in-hospital mortality risk in patients with acute ischemic stroke: A MIMIC-IV retrospective analysis. Medicine (Baltimore) 2024; 103:e38306. [PMID: 38788014 PMCID: PMC11124755 DOI: 10.1097/md.0000000000038306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
We investigated the relationship among red cell distribution width (RDW), to total serum calcium (TSC) ratio (RCR), and in-hospital mortality in patients with acute ischemic stroke (AIS). This study was a retrospective analysis. The data of 2700 AIS patients was retrospectively analyzed from the Medical Information Mart for Intensive Care database (version IV). The main outcome of interest was in-hospital mortality. A Cox proportional hazards regression model was used to determine whether RCR was independently associated with in-hospital mortality. The Kaplan-Meier method was used to plot the survival curves for RCR. Subgroup analyses were performed to measure the mortality across various subgroups. The area under curve (AUC) of receiver operating characteristic curve (ROC) was calculated to ascertain the quality of RCR as a predictor of in-hospital mortality in patients with AIS. In the multivariate analysis, statistically significant differences were identified in age, ethnicity, length of ICU stay, mechanical ventilation, sequential organ failure assessment (SOFA) score, RDW, hemoglobin, RCR, whether taking anticoagulants, hyperlipidemia, and atrial fibrillation (P < .05). A threshold inflection point value of 1.83 was obtained through a two-piecewise regression model. There was a non-linear relationship between RCR and hospital mortality in patients with AIS. The hazard ratio (HR) and the 95% confidence intervals (CI) on the right and left of the inflection point were 0.93 (0.57-1.51; P = .7660) and 2.96 (1.37-6.42; P = .0060), respectively. The Kaplan-Meier curve indicated that survival rates were higher when RCR was ≤ 1.83 and lower when RDW was > 1.83 after adjustment for age, gender, BMI, ethnicity. The area under curve (AUC) of RCR was 0.715. A higher RCR was associated with an increased risk of in-hospital mortality in patients with AIS.
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Affiliation(s)
- Xue-qing Zhang
- Department of Nursing, The First People’s Hospital of Changde City, Changde, People’s Republic of China
| | - Jin-hua Shen
- Department of Nursing, The First People’s Hospital of Changde City, Changde, People’s Republic of China
| | - Quan Zhou
- Department of Science and Education, The First People’s Hospital of Changde City, Changde, People’s Republic of China
| | - Xiang-Jie Duan
- Department of Infectious Diseases, The First People’s Hospital of Changde City, Changde, People’s Republic of China
| | - Ya-fen Guo
- Department of Nursing, The First People’s Hospital of Changde City, Changde, People’s Republic of China
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Goto S, Hamano T, Fujii H, Taniguchi M, Abe M, Nitta K, Nishi S. Hypocalcemia and cardiovascular mortality in cinacalcet users. Nephrol Dial Transplant 2024; 39:637-647. [PMID: 37777840 DOI: 10.1093/ndt/gfad213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Calcimimetics are widely used in hemodialysis patients and influence serum calcium levels. Although the Kidney Disease: Improving Global Outcomes guidelines argued that low calcium levels induced by calcimimetics may be harmless, large observational studies investigating the association between hypocalcemia and mortality are scarce. We investigated the association between serum calcium levels and cardiovascular mortality in calcimimetics users using the nationwide Japanese registry for dialysis patients. METHODS In this 9-year prospective cohort study, the baseline data were collected at the end of 2009. We enrolled patients on maintenance hemodialysis or hemodiafiltration. We employed three models (baseline, time-dependent and time-averaged) to conduct Cox proportional hazard regression analyses. RESULTS Cinacalcet was prescribed to 12.7% (N = 22 853) at baseline. The median observation period was 98 (interquartile range 40-108) months and 108 (interquartile range 59-108) months in the whole cohort (N = 180 136) and in cinacalcet users, respectively. Three-quarters of survivors at the end of 2019 had continued calcimimetic therapy for 10 years, corresponding to a mean annual dropout rate of 2.9%. Hypocalcemia was not associated with cardiovascular mortality in the baseline or time-averaged model. In the time-dependent model, however, the lowest calcium decile (corrected calcium <8.4 mg/dL) was significantly associated with higher cardiovascular mortality than the reference (corrected calcium 8.7-8.9 mg/dL) in both cinacalcet users and all patients [hazard ratio (95% confidence interval) 1.32 (1.00, 1.75) and 1.15 (1.05, 1.26), respectively]. Hypocalcemia was especially associated with sudden death and death due to hemorrhagic stroke, heart failure and ischemic heart disease. Higher rate of fatal and non-fatal cardiovascular events was observed in hypocalcemic patients regardless of cinacalcet usage. CONCLUSIONS Our findings suggest that transient hypocalcemia was associated with an increased risk of cardiovascular death independent of cinacalcet usage. We should pay attention to hypocalcemia transiently induced by cinacalcet.
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Affiliation(s)
- Shunsuke Goto
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takayuki Hamano
- Department of Nephrology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideki Fujii
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masatomo Taniguchi
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Fukuoka Renal Clinic, Fukuoka, Japan
| | - Masanori Abe
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kosaku Nitta
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
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Yamaguchi S, Hamano T, Yonemoto S, Fujii N, Isaka Y. Low-dosage active vitamin D modifies the relationship between hypocalcemia and overhydration in patients with advanced chronic kidney disease. J Nephrol 2024; 37:535-538. [PMID: 38180728 DOI: 10.1007/s40620-023-01801-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/28/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Satoshi Yamaguchi
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Nephrology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Takayuki Hamano
- Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Sayoko Yonemoto
- Department of Nephrology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan
| | - Naohiko Fujii
- Department of Nephrology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
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Li X, He W, Song Q, Ding Q, Zhang X, Zeng Z, Deng W, Deng G, Guan L, Hong W, Liu Y, Shu F, Xu L, Tan N, Ma J, Jiang L. The Prognostic Value of Serum Calcium Levels in Elderly Dilated Cardiomyopathy Patients. Glob Heart 2024; 19:25. [PMID: 38434155 PMCID: PMC10906334 DOI: 10.5334/gh.1304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
Background It is unclear whether serum calcium on admission is associated with clinical outcomes in dilated cardiomyopathy (DCM). In this study, we conducted a retrospective study spanning a decade to investigate the prognostic value of baseline calcium in elderly patients with DCM. Methods A total of 1,089 consecutive elderly patients (age ≥60 years) diagnosed with DCM were retrospectively enrolled from January 2010 to December 2019. Univariate and multivariate analyses were performed to investigate the association of serum calcium with their clinical outcomes. Results In this study, the average age of the subjects was 68.36 ± 6.31 years. Receiver operating characteristic (ROC) curve analysis showed that serum calcium level had a great sensitivity and specificity for predicting in-hospital death, with an AUC of 0.732. Kaplan-Meier survival analysis showed that patients with a serum calcium >8.62 mg/dL had a better prognosis than those with a serum calcium ≤8.62 mg/dL (log-rank χ2 40.84, p < 0.001). After adjusting for several common risk factors, a serum calcium ≤8.62 mg/dL was related to a higher risk of long-term mortality (HR: 1.449; 95% CI: 1.115~1.882; p = 0.005). Conclusions Serum calcium level could be served as a simple and affordable tool to evaluate patients' prognosis in DCM.
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Affiliation(s)
- Xinyi Li
- School of Medicine, South China University of Technology, Guangzhou 510006, China
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Wenfei He
- Department of Cardiology, Guangdong Provincial People’s Hospital’s Nanhai Hospital, The Second People’s Hospital of Nanhai District, Foshan 528000, China
| | - Qiqi Song
- School of Medicine, South China University of Technology, Guangzhou 510006, China
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Qingshan Ding
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Xiaonan Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Zhigang Zeng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Weiping Deng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Gang Deng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Lichang Guan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Wanzi Hong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Yaoxin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Fen Shu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Lishu Xu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Jinjin Ma
- School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - Lei Jiang
- School of Medicine, South China University of Technology, Guangzhou 510006, China
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
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Zhao K, Zheng Q, Zhou J, Zhang Q, Gao X, Liu Y, Li S, Shan W, Liu L, Guo N, Tian H, Wei Q, Hu X, Cui Y, Geng X, Wang Q, Cui W. Associations between serum electrolyte and short-term outcomes in patients with acute decompensated heart failure. Ann Med 2023; 55:155-167. [PMID: 36519243 PMCID: PMC9851236 DOI: 10.1080/07853890.2022.2156595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is a dearth of comprehensive studies on the association between serum electrolyte and adverse short-term prognosis of Chinese patients with acute decompensated heart failure (ADHF). PATIENTS AND METHODS A total of 5166 patients with ADHF were divided into four serum electrolyte-related study populations (potassium (n = 5145), sodium (n = 5135), chloride (n = 4966), serum total calcium (STC) (n = 4143)) under corresponding exclusions. Different logistic regression models were utilized to gauge the association between these electrolytes or the number of electrolyte abnormalities and the risk of a composite of all-cause mortality or 30-day heart failure (HF) readmission. RESULTS In multivariable adjusted analysis, patients with potassium below 3.5 mmol/L (odds ratios (ORs) 1.45; 95% confidence interval (CI):1.07-1.95), 4.01-4.50 mmol/L (OR: 1.29, CI: 1.02-1.62), 4.51-5.00 mmol/L (OR: 1.43, CI: 1.08-1.90) and above 5.00 mmol/L (OR: 1.74, CI: 1.21-2.51) had an increased risk of outcome when compared with potassium at 3.50-4.00 mmol/L. Sodium levels were inversely related to the risk of a composite outcome (<130 mmol/L: OR: 2.73 (95% CI, 1.81-4.12); 130-134 mmol/L: OR, 1.97 (CI, 1.45-2.68); 135-140 mmol/L: OR, 1.45 (CI, 1.17-1.81); p for trend < 0.001) in comparison with sodium at 141-145 mmol/L. Chloride < 95 mmol/L corresponded to a higher risk of a composite outcome with an OR of 1.65 (95% CI, 1.16-2.37) in contrast to chloride levels at 101-105 mmol/L. In addition, the adjusted ORs (95% CI) for a composite outcome comparing the STC < 2.00 and 2.00-2.24 vs. 2.25-2.58 mmol/L were 0.98 (0.69-1.43) and 1.13 (0.89-1.44), respectively. Besides that, the number of electrolyte abnormalities was positively related to the risk of a composite outcome (N = 1, OR 1.40, 95% CI: 1.13-1.73; N = 2, OR 2.51, 95% CI: 1.85-3.42; N = 3, OR 2.47, 95% CI: 1.45-4.19; p for trend < 0.001) in comparison with N = 0. CONCLUSIONS A deviation of potassium levels from 3.50 to 4.00 mmol/L, lower sodium levels and hypochloremia were associated with poorer short-term prognosis of ADHF. Furthermore, the number of electrolyte abnormalities positively correlated with adverse short-term prognosis of patients with ADHF. Key MessagesADHF patients with baseline serum potassium at first half part of normal range (3.50-4.00 mmol/L) may herald the lowest risk of recent cardiovascular events.Serum sodium and chloride levels exhibit discrepancies in terms of risk of short-term adverse events of ADHF patients.The number of electrolyte abnormalities is a significant predictor of poor short-term prognosis in patients with ADHF. CLINICAL TRIAL REGISTRATION URL http://www.chictr.org.cn/showproj.aspx?proj=23139. Unique identifier: ChiCTR-POC-17014020.
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Affiliation(s)
- Kai Zhao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qun Zheng
- Department of Cardiology, Hengshui People's Hospital, Hengshui, China
| | - Jiang Zhou
- Department of Cardiology, Chengde Central Hospital, Chengde, China
| | - Qi Zhang
- Department of Cardiology, First Central Hospital of Baoding, Baoding, China
| | - Xiaoli Gao
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Cangzhou, China
| | - Yinghua Liu
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Cangzhou, China
| | - Senlin Li
- Department of Cardiology, First Hospital of Zhangjiakou, Zhangjiakou, China
| | - Weichao Shan
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Li Liu
- Department of Cardiology, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Nan Guo
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, China
| | - Hongsen Tian
- Department of Cardiology, Handan Central Hospital, Handan, China
| | - Qingmin Wei
- Department of Cardiology, Xingtai People's Hospital, Xingtai, China
| | - Xitian Hu
- Department of Cardiology, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Yingkai Cui
- Department of Cardiology, The 252nd Hospital of People's Liberation Army, Baoding, China
| | - Xue Geng
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qian Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Yang M, Miao J, Du L, Wang J, Yang J, Lu J, Fan X, Huang C, Fu Z, Xu Z, Song M, Ma H, Jin G, Hu Z, Hang D, Shen H. Serum calcium concentrations and risk of all-cause and cause-specific mortality: results from two prospective cohorts. J Clin Endocrinol Metab 2023:7046139. [PMID: 36806939 DOI: 10.1210/clinem/dgad078] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/20/2023]
Abstract
CONTEXT Calcium plays a critical role in various physiological activities. However, the association between circulating calcium concentrations and mortality in a general healthy population remains undetermined. OBJECTIVE To examine the association of serum calcium concentrations with all-cause and cause-specific mortality. METHODS Leveraging data from the UK Biobank (n=361 662) and the US National Health and Nutrition Examination Survey (NHANES, n=36 985), we prospectively examined the association of serum calcium concentrations with all-cause and cause-specific mortality using Cox proportional hazard and restricted-cubic spline models. RESULTS During a median follow-up of 12.0 years, UK Biobank documented 18 327 deaths, including 3119 (17.0%) from cardiovascular disease (CVD) and 9599 (52.4%) from cancer. We found a U-shape relationship of albumin-adjusted calcium concentrations with all-cause and CVD mortality. Compared to participants with moderate calcium levels (the third quintile, Q3), those with low and high levels had an increased risk of all-cause (hazard ratio [HR]=1.02 for Q1 vs. Q3; 1.10 for Q5 vs. Q3) and CVD mortality (HR=1.11 for Q1 vs. Q3; 1.25 for Q5 vs. Q3). In contrast, there was a linear positive relationship with cancer mortality (HR=1.09 for Q5 vs. Q1). Similar results for all-cause, CVD, and cancer mortality were observed in US NHANES. CONCLUSIONS Our findings provide novel insights into the association between serum calcium concentrations and mortality in the general healthy population.
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Affiliation(s)
- Mingjia Yang
- Department of Epidemiology, School of Public Health, Southeast University, Nanjing 210009, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Junyan Miao
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Lingbin Du
- Department of Cancer Prevention, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Jiayu Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Jing Yang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Jiayi Lu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Xikang Fan
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Changzhi Huang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zan Fu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zekuan Xu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Hongxia Ma
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine and China International Cooperation Center for Environment and Human Health, Gusu School, Nanjing Medical University 211166, Nanjing, China
| | - Guangfu Jin
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine and China International Cooperation Center for Environment and Human Health, Gusu School, Nanjing Medical University 211166, Nanjing, China
| | - Zhibin Hu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine and China International Cooperation Center for Environment and Human Health, Gusu School, Nanjing Medical University 211166, Nanjing, China
| | - Dong Hang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine and China International Cooperation Center for Environment and Human Health, Gusu School, Nanjing Medical University 211166, Nanjing, China
| | - Hongbing Shen
- Department of Epidemiology, School of Public Health, Southeast University, Nanjing 210009, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine and China International Cooperation Center for Environment and Human Health, Gusu School, Nanjing Medical University 211166, Nanjing, China
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Hou X, Hu J, Liu Z, Wang E, Guo Q, Zhang Z, Song Z. L-shaped association of serum calcium with all-cause and CVD mortality in the US adults: A population-based prospective cohort study. Front Nutr 2023; 9:1097488. [PMID: 36687714 PMCID: PMC9849810 DOI: 10.3389/fnut.2022.1097488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
Background Calcium is involved in many biological processes, but the impact of serum calcium levels on long-term mortality in general populations has been rarely investigated. Methods This prospective cohort study analyzed data from the National Health and Nutrition Examination Survey (1999-2018). All-cause mortality, cardiovascular disease (CVD) mortality, and cancer mortality were obtained through linkage to the National Death Index. Survey-weighted multivariate Cox regression was performed to compute hazard ratios (HRs) and 95% confidential intervals (CIs) for the associations of calcium levels with risks of mortality. Restricted cubic spline analyses were performed to examine the non-linear association of calcium levels with all-cause and disease-specific mortality. Results A total of 51,042 individuals were included in the current study. During an average of 9.7 years of follow-up, 7,592 all-cause deaths were identified, including 2,391 CVD deaths and 1,641 cancer deaths. Compared with participants in the first quartile (Q1) of serum calcium level [≤2.299 mmol/L], the risk of all-cause mortality was lower for participants in the second quartile (Q2) [2.300-2.349 mmol/L], the third quartile (Q3) [2.350-2.424 mmol/L] and the fourth quartile (Q4) [≥2.425 mmol/L] with multivariable-adjusted HRs of 0.81 (95% CI, 0.74-0.88), 0.78 (95% CI, 0.71-0.86), and 0.80 (95% CI, 0.73, 0.88). Similar associations were observed for CVD mortality, with HRs of 0.82 (95% CI, 0.71-0.95), 0.87 (95% CI, 0.74-1.02), and 0.83 (95% CI, 0.72, 0.97) in Q2-Q4 quartile. Furthermore, the L-shaped non-linear associations were detected for serum calcium with the risk of all-cause mortality. Below the median of 2.350 mmol/L, per 0.1 mmol/L higher serum calcium was associated with a 24% lower risk of all-cause mortality (HR: 0.76, 95% CI, 0.70-0.83), however, no significant changes were observed when serum calcium was above the median. Similar L-shaped associations were detected for serum calcium with the risk of CVD mortality with a 25% reduction in the risk of CVD death per 0.1 mmol/L higher serum calcium below the median (HR: 0.75, 95% CI, 0.65-0.86). Conclusion L-shaped associations of serum calcium with all-cause and CVD mortality were observed in US adults, and hypocalcemia was associated with a higher risk of all-cause mortality and CVD mortality.
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Affiliation(s)
- Xinran Hou
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Hu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhuoyi Liu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - E. Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Qulian Guo
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhong Zhang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Zongbin Song
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Zongbin Song,
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Wang H, Wang R, Tian J. Association of admission serum calcium level with left ventricular dysfunction in patients with acute coronary syndrome. Front Cardiovasc Med 2022; 9:1018048. [DOI: 10.3389/fcvm.2022.1018048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022] Open
Abstract
BackgroundThe relationship between serum calcium and left ventricular function in patients with acute coronary syndrome (ACS) has not been explored. Our aim was to investigate the correlation of admission serum calcium with left ventricular dysfunction in ACS patients.MethodsIn this cross-sectional study, 658 ACS patients who were admitted in the Department of Cardiovascular Disease from June 1st, 2019 to December 31st, 2019 were enrolled in the present study. Serum calcium and B-type natriuretic peptide (BNP) were measured at admission. Left ventricular ejection fraction (LVEF) was assessed using echocardiography. The correlation between admission serum calcium and left ventricular dysfunction was analyzed.ResultsWhen stratified by serum calcium quartiles calculated from all patients, patients with lower serum calcium quartile showed a markedly higher BNP and lower LVEF (P < 0.05). Patients with LVEF ≤ 50% showed a significantly lower serum calcium and higher BNP compared to those with LVEF> 50% (P < 0.05). Admission serum calcium was positively correlated with LVEF (P < 0.01) but negatively correlated with BNP (P < 0.01). Multivariate logistic regression analysis showed that lower serum calcium (adjusted OR: 0.720, 95% CI: 0.519–0.997, P = 0.048) was independently associated with BNP ≥ 300 pg/ml in ACS patients. Using LVEF as a dependent variable, no significant correlation between low serum calcium and left ventricular systolic dysfunction was found in ACS patients.ConclusionsIn patients with ACS, admission serum calcium was positively correlated with LVEF and negatively with BNP. Lower admission serum calcium was an independent risk factor for elevated BNP.
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Su W, Zhu JG, Zhao XQ, Chen H, Li WP, Li HW. Altered serum calcium homeostasis independently predicts mortality in patients with acute coronary syndrome: a retrospective observational cohort study. BMJ Open 2021; 11:e049957. [PMID: 34848511 PMCID: PMC8634212 DOI: 10.1136/bmjopen-2021-049957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Serum calcium levels (sCa) were reported to be associated with risk of cardiovascular diseases. The aim of this study was to analyse the association between sCa and long-term mortality in patients with acute coronary syndrome (ACS). DESIGN A retrospective observational cohort study. SETTING Single-centre study with participants recruited from the local area. PARTICIPANTS A total of consecutive 13 772 patients with ACS were included in this analysis. Patients were divided based on their sCa profile (≤2.1 mmol/L, 2.1-2.2 mmol/L, 2.2-2.3 mmol/L, 2.3-2.4 mmol/L, 2.4-2.5 mmol/L,>2.5 mmol/L) and followed up for a median of 2.96 years (IQR 1.01-4.07). PRIMARY OUTCOME Long-term all-cause mortality. RESULTS During a median follow-up period of 2.96 years, patients with sCa ≤2.1 mmol/L had the highest cumulative incidences of all-cause mortality (16.7%), whereas those with sCa 2.4-2.5 mmol/L had the lowest cumulative incidences of all-cause mortality (3.5%). After adjusting for potentially confounding variables, the Cox analysis revealed that compared with the reference group (sCa 2.4-2.5 mmol/L), all the other groups had higher mortality except for the sCa 2.3-2.4 mmol/L group (HR, 1.32, 95% CI 0.93 to 1.87). Restricted cubic splines showed that the relationship between sCa and all-cause mortality seemed to be U shaped. The optimal sCa cut-off point, 2.35 mmol/L, was determined based on the shape of restricted cubic splines. CONCLUSIONS Altered serum calcium homeostasis at admission independently predicts all-cause mortality in patients with ACS. In addition, a U-shaped relationship between sCa and all-cause mortality exists, and maintaining sCa at approximately 2.35 mmol/L may minimise the risk of mortality.
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Affiliation(s)
- Wen Su
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jie-Gao Zhu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xue-Qiao Zhao
- Clinical Atherosclerosis Research Lab, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Hui Chen
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei-Ping Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hong-Wei Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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11
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Wang CH, Han S, Tong F, Li Y, Li ZC, Sun ZJ. Risk prediction model of in-hospital mortality in heart failure with preserved ejection fraction and mid-range ejection fraction: a retrospective cohort study. Biomark Med 2021; 15:1223-1232. [PMID: 34498488 DOI: 10.2217/bmm-2021-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To develop and validate internally a multivariate risk model for predicting the in-hospital mortality of patients with heart failure with preserved ejection fraction (HFpEF) and heart failure with mid-range ejection fraction (HFmrEF). Methods & results: The clinical data of 8172 inpatients with HFpEF and HFmrEF was used to establish a retrospective database. These patients, among whom 307 in-hospital deaths (3.8%) occurred, were randomly assigned to derivation and verification cohort. Among the extracted data from the derivation cohort were nine variables significantly related to in-hospital mortality, which were scored 0-4, for a total score of 24, which allowed formation of a risk predictive model. The verification cohort was then used to validate the discrimination and calibration capacities of this predictive model: the area under curve equaled 0.8575 (0.8285, 0.8865) for the derivation cohort, and 0.8323 (0.7999, 0.8646) for the verification cohort. According to this risk score, we divided patients into four risk classes (low-, medium-, high- and extremely high-risk) and revealed that the risk of in-hospital mortality increased with increasing risk class with an obvious linear relationship between actual and predicted mortality (r = 0.998, p < 0.001). Conclusion: The model based on nine common clinical variables should provide an accurate prediction of in-hospital mortality and appears to be a reliable risk classification system for patients with HFpEF and HFmrEF.
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Affiliation(s)
- Chuan-He Wang
- Department of Cardiology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi Zone, Shenyang, China
| | - Su Han
- Department of Cardiology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi Zone, Shenyang, China
| | - Fei Tong
- Department of Cardiology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi Zone, Shenyang, China
| | - Ying Li
- Department of Cardiology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi Zone, Shenyang, China
| | - Zhi-Chao Li
- Department of Cardiology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi Zone, Shenyang, China
| | - Zhi-Jun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi Zone, Shenyang, China
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Li F, Xin H, Zhang J, Fu M, Zhou J, Lian Z. Prediction model of in-hospital mortality in intensive care unit patients with heart failure: machine learning-based, retrospective analysis of the MIMIC-III database. BMJ Open 2021; 11:e044779. [PMID: 34301649 PMCID: PMC8311359 DOI: 10.1136/bmjopen-2020-044779] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The predictors of in-hospital mortality for intensive care units (ICUs)-admitted heart failure (HF) patients remain poorly characterised. We aimed to develop and validate a prediction model for all-cause in-hospital mortality among ICU-admitted HF patients. DESIGN A retrospective cohort study. SETTING AND PARTICIPANTS Data were extracted from the Medical Information Mart for Intensive Care (MIMIC-III) database. Data on 1177 heart failure patients were analysed. METHODS Patients meeting the inclusion criteria were identified from the MIMIC-III database and randomly divided into derivation (n=825, 70%) and a validation (n=352, 30%) group. Independent risk factors for in-hospital mortality were screened using the extreme gradient boosting (XGBoost) and the least absolute shrinkage and selection operator (LASSO) regression models in the derivation sample. Multivariate logistic regression analysis was used to build prediction models in derivation group, and then validated in validation cohort. Discrimination, calibration and clinical usefulness of the predicting model were assessed using the C-index, calibration plot and decision curve analysis. After pairwise comparison, the best performing model was chosen to build a nomogram according to the regression coefficients. RESULTS Among the 1177 admissions, in-hospital mortality was 13.52%. In both groups, the XGBoost, LASSO regression and Get With the Guidelines-Heart Failure (GWTG-HF) risk score models showed acceptable discrimination. The XGBoost and LASSO regression models also showed good calibration. In pairwise comparison, the prediction effectiveness was higher with the XGBoost and LASSO regression models than with the GWTG-HF risk score model (p<0.05). The XGBoost model was chosen as our final model for its more concise and wider net benefit threshold probability range and was presented as the nomogram. CONCLUSIONS Our nomogram enabled good prediction of in-hospital mortality in ICU-admitted HF patients, which may help clinical decision-making for such patients.
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Affiliation(s)
- Fuhai Li
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hui Xin
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jidong Zhang
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mingqiang Fu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingmin Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhexun Lian
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Admission Serum Ionized and Total Calcium as New Predictors of Mortality in Patients with Cardiogenic Shock. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6612276. [PMID: 33928149 PMCID: PMC8049792 DOI: 10.1155/2021/6612276] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/05/2021] [Accepted: 03/20/2021] [Indexed: 12/22/2022]
Abstract
Background Although serum calcium has been proven to be a predictor of mortality in a wide range of diseases, its prognostic value in critically ill patients with cardiogenic shock (CS) remains unknown. This retrospective observational study is aimed at investigating the association of admission calcium with mortality among CS patients. Methods Critically ill patients diagnosed with CS in the Medical Information Mart for Intensive Care-III (MIMIC-III) database were included in our study. The study endpoints included 30-day, 90-day, and 365-day all-cause mortalities. First, admission serum ionized calcium (iCa) and total calcium (tCa) levels were analyzed as continuous variables using restricted cubic spline Cox regression models to evaluate the possible nonlinear relationship between serum calcium and mortality. Second, patients with CS were assigned to four groups according to the quartiles (Q1-Q4) of serum iCa and tCa levels, respectively. In addition, multivariable Cox regression analyses were used to assess the independent association of the quartiles of iCa and tCa with clinical outcomes. Results A total of 921 patients hospitalized with CS were enrolled in this study. A nonlinear relationship between serum calcium levels and 30-day mortality was observed (all P values for nonlinear trend < 0.001). Furthermore, multivariable Cox analysis showed that compared with the reference quartile (Q3: 1.11 ≤ iCa < 1.17 mmol/L), the lowest serum iCa level quartile (Q1: iCa < 1.04 mmol/L) was independently associated with an increased risk of 30-day mortality (Q1 vs. Q3: HR 1.35, 95% CI 1.00-1.83, P = 0.049), 90-day mortality (Q1 vs. Q3: HR 1.36, 95% CI 1.03-1.80, P = 0.030), and 365-day mortality (Q1 vs. Q3: HR 1.28, 95% CI 1.01-1.67, P = 0.046) in patients with CS. Conclusions Lower serum iCa levels on admission were potential predictors of an increased risk of mortality in critically ill patients with CS.
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Kretzschmar T, Wu JMF, Schulze PC. Mitochondrial Homeostasis Mediates Lipotoxicity in the Failing Myocardium. Int J Mol Sci 2021; 22:1498. [PMID: 33540894 PMCID: PMC7867320 DOI: 10.3390/ijms22031498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 01/17/2023] Open
Abstract
Heart failure remains the most common cause of death in the industrialized world. In spite of new therapeutic interventions that are constantly being developed, it is still not possible to completely protect against heart failure development and progression. This shows how much more research is necessary to understand the underlying mechanisms of this process. In this review, we give a detailed overview of the contribution of impaired mitochondrial dynamics and energy homeostasis during heart failure progression. In particular, we focus on the regulation of fatty acid metabolism and the effects of fatty acid accumulation on mitochondrial structural and functional homeostasis.
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Affiliation(s)
| | | | - P. Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, 07747 Jena, Thüringen, Germany; (T.K.); (J.M.F.W.)
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15
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Shirakabe A, Kiuchi K, Kobayashi N, Okazaki H, Matsushita M, Shibata Y, Shigihara S, Sawatani T, Tani K, Otsuka Y, Asai K, Shimizu W. Importance of the Corrected Calcium Level in Patients With Acute Heart Failure Requiring Intensive Care. Circ Rep 2020; 3:44-54. [PMID: 33693289 PMCID: PMC7939791 DOI: 10.1253/circrep.cr-20-0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/20/2020] [Accepted: 11/12/2020] [Indexed: 12/28/2022] Open
Abstract
Background: Serum calcium (Ca) concentrations in the acute phase of acute heart failure (AHF) have not been not sufficiently investigated. Methods and Results: This study enrolled 1,291 AHF patients and divided them into 3 groups based on original and corrected Ca concentrations: (1) hypocalcemia (both original and corrected Ca ≤8.7 mg/dL; n=651); (2) pseudo-hypocalcemia (original and corrected Ca ≤8.7 and >8.7 mg/dL, respectively; n=300); and (3) normal/hypercalcemia (both original and corrected Ca >8.7 mg/dL; n=340). AHF patients were also divided into 2 groups based on corrected Ca concentrations: (1) corrected hypocalcemia (corrected Ca ≤8.7 mg/dL; n=651); and (2) corrected normal/hypercalcemia (corrected Ca >8.7 mg/dL; n=640). Of the 951 patients with original hypocalcemia (≤8.7 mg/dL), 300 (31.5%) were classified as corrected normal/hypercalcemia after correction of Ca concentrations by serum albumin. The prognoses in the pseudo-hypocalcemia, low albumin, and corrected normal/hypercalcemia groups, including all-cause death within 730 days, were significantly poorer than in the other groups. Multivariate Cox regression analysis showed that classification into the pseudo-hypocalcemia, hypoalbumin, and corrected normal/hypercalcemia groups independently predicted 730-day all-cause death (hazard ratios [95% confidence intervals] of 1.497 [1.153-1.943], 2.392 [1.664-3.437], and 1.294 [1.009-1.659], respectively). Conclusions: Corrected normal/hypercalcemia was an independent predictor of prognosis because this group included patients with pseudo-hypocalcemia, which was affected by the serum albumin concentration.
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Affiliation(s)
- Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital Chiba Japan
| | - Kazutaka Kiuchi
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital Chiba Japan
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital Chiba Japan
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital Chiba Japan
| | - Masato Matsushita
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital Chiba Japan
| | - Yusaku Shibata
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital Chiba Japan
| | - Shota Shigihara
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital Chiba Japan
| | - Tomofumi Sawatani
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital Chiba Japan
| | - Kenichi Tani
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital Chiba Japan
| | - Yusuke Otsuka
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital Chiba Japan
| | - Kuniya Asai
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital Chiba Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School Tokyo Japan
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Liu F, Zhang H, Li Y, Lu X. Hypocalcaemia predicts 12-month re-hospitalization in heart failure. Eur J Clin Invest 2020; 50:e13261. [PMID: 32374904 DOI: 10.1111/eci.13261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 04/06/2020] [Accepted: 04/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Potential pathophysiology of heart failure with preserved ejection fraction (HFpEF) has not been fully explored. The aim of the study was to reveal the association of serum calcium concentration at baseline with 12-month clinical outcome in the disease. MATERIALS AND METHODS A total of 350 patients with newly diagnosed HFpEF were included in this prospective observational study. There were no malignant tumour, kidney disease, thyroid disease, calcium and vitamin D supplements in the patients. All of them received 12-month follow-up, and endpoints were cardiac re-hospitalization and death. Baseline serum calcium concentration was measured using AIA2000ST enzyme immunoassay analyser. Cardiopulmonary exercise, six-minute walk distance test, EQ5D questionnaire and cardiac ultrasound were performed to evaluate exercise capacity, quality of life and left ventricle function. RESULTS Multivariate COX regression analysis revealed that baseline hypocalcaemia was associated with the increased risk of cardiac re-hospitalization and death during the follow-up period (HR: 2.10, 95% CI: 1.69-2.61; HR: 8.26, 95% CI: 2.88-23.70). Furthermore, baseline hypocalcaemia was related to the deterioration of 6-minute walk distance, quality of life score (EQ-5D), right quadriceps strength, left atrium volume index and left ventricular ejection fraction during the follow-up period (HR: 1.65, 95% CI: 1.21-2.26; HR: 1.55, 95% CI: 1.12-2.11; HR: 2.56, 95% CI: 1.68-3.89; HR: 1.44, 95% CI: 1.03-1.98; HR: 1.36, 95% CI: 1.02-1.80). CONCLUSION Baseline hypocalcaemia predicted 12-month cardiac re-hospitalization and death in HFpEF patients without calcium and vitamin D supplements partly through left ventricle and skeletal muscle function pathways.
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Affiliation(s)
- Feng Liu
- Department of Intensive Care Unit, Huaihe Hospital of Henan University, Kaifeng, China
| | - Han Zhang
- Department of Cardiology, Huaihe Hospital of Henan University, Kaifeng, China
| | - Yanming Li
- Department of Cardiology, Huaihe Hospital of Henan University, Kaifeng, China
| | - Xueli Lu
- Department of Cardiology, Huaihe Hospital of Henan University, Kaifeng, China
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Azzam E, Elsabbagh N, Elgayar N, Younan D. Relation between vitamin D and geriatric syndrome. Clin Nutr ESPEN 2019; 35:123-127. [PMID: 31987105 DOI: 10.1016/j.clnesp.2019.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/19/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Vitamin D level is a common health problem for elderly persons and it is associated with a decrease in physical performance, furthermore, it has been demonstrated that those with low serum vitamin D level has more risk of cognitive impairment, depression and anxiety. AIM The aim of the study was to estimate relation of vitamin D and geriatric syndrome. METHODS A prospective study was done on 50 subjects who were normal elderly persons above 65 years. All the participants were subjected to full history taking, complete physical examination, laboratory assessment including serum 25-hydroxyvitamin D (OH)D by enzyme linked immunosorbent assay (ELISA) and geriatric syndrome assessment using 5 methods namely fall risk assessment using timed up &go test, mini-mental state examination (MMSE), geriatric depressive scale, mini nutritional assessment and Tinetti performance - oriented mobility assessment (POMA). RESULTS The number of patients who were vitamin D deficient (<12 ng/ml), insufficient (12-20 ng/ml) and sufficient (>20 ng/ml) were 11, 24 and 15 respectively. There was significant p association between low vitamin D level and female gender (p = 0.024), advanced age (p = 0.026), no-sun exposure jobs (p = 0.001) and nursing home residency. Mini mental state examination (p = 0.006) and geriatric depressive scale (p = 0.002) had a significant positive correlation with low vitamin D level while mini nutritional assessment (p = 1.000), timed up and go test (p = 0.225) and POMA score (p = 0.133) had no significant correlation with low vitamin D level. CONCLUSION There is correlation finding between vitamin D deficiency and advanced age, cognitive dysfunction, and depression.
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Affiliation(s)
- Eman Azzam
- Internal Medicine, Faculty of Medicine, Alexandria, University, Egypt.
| | - Noha Elsabbagh
- Internal Medicine, Faculty of Medicine, Alexandria, University, Egypt
| | - Nany Elgayar
- Internal Medicine, Faculty of Medicine, Alexandria, University, Egypt
| | - Doreen Younan
- Clinical Pathology, Faculty of Medicine, Alexandria University, Egypt
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Usefulness of Serum Calcium in the Risk Stratification of Midterm Mortality among Patients with Acute Coronary Syndrome. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9542054. [PMID: 31781656 PMCID: PMC6875235 DOI: 10.1155/2019/9542054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/29/2019] [Accepted: 10/05/2019] [Indexed: 02/07/2023]
Abstract
Serum calcium has been reported to be a predictor of short-term prognosis; however, evidence regarding its association with midterm mortality is scarce. We investigated the association between serum calcium levels at admission and midterm mortality in a retrospective cohort of 2594 consecutive patients with acute coronary syndrome (ACS) who presented to the First Affiliated Hospital of Harbin Medical University from November 2014 to December 2016. Patients were assigned to 4 groups according to the quartiles of serum calcium levels (Ca-Q1-4) and were followed longitudinally for the time to all-cause death. During a median follow-up period of 21.8 months (17.5∼29.5, IQR), 124 patients died (4.8%) of all causes. Kaplan-Meier curves showed that the incidence of midterm mortality differed significantly (log-rank P=0.038) among the quartiles of serum calcium levels at admission. After adjustment for the confounders that were significant in the univariate analysis, the hazard ratios for the lowest quartile of serum calcium was 1.86 (95% CI, 1.05-3.31; P=0.033), compared with the third quartile (reference group). A multiple restricted cubic spline regression model suggested a reverse J-shaped association between serum calcium levels and midterm mortality, and the lowest risk of mortality was associated with approximately 2.32 mmol/l of serum calcium. In conclusion, the serum calcium level is an independent predictor of all-cause midterm mortality among ACS patients. Patients with abnormal serum calcium levels at admission need more targeted treatments.
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