Deans' stroke musings: Admission Serum Calcium Level and Short-Term Mortality After Acute Ischemic Stroke: A Secondary Analysis Based on a Norwegian Retrospective Cohort

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, June 23, 2022

Admission Serum Calcium Level and Short-Term Mortality After Acute Ischemic Stroke: A Secondary Analysis Based on a Norwegian Retrospective Cohort

Well shit, you described something, but told us nothing about what should be done. Fucking useless research.

Admission Serum Calcium Level and Short-Term Mortality After Acute Ischemic Stroke: A Secondary Analysis Based on a Norwegian Retrospective Cohort

Yuzhao Lu¹,

Xin Ma²,

Kiarash Tazmini³,

Ming Yang⁴^*,

Xiaobing Zhou¹^* and

Yang Wang^1,5^*

¹Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
²Department of Thoracic Surgery, Jingshan Union Hospital of Huazhong University of Science and Technology, Wuhan, China
³Department of Endocrinology, Morbid Obesity and Preventive Medicine, Faculty of Medicine, Oslo University Hospital, Oslo, Norway
⁴Department of Neurosurgery, Central Theater General Hospital of Chinese PLA, Wuhan, China
⁵Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

Background: Disturbed serum calcium levels are related to the risk of stroke. However, previous studies exploring the correlation between serum calcium and the clinical outcome of ischemic stroke (IS) have shown inconsistent results.

Object: The study aimed to investigate the relationship between admission serum calcium and 30-day mortality in patients with IS.

Methods: A total of 876 IS patients from a Norwegian retrospective cohort were included for secondary analysis. The exposure variable and the primary outcome were albumin-corrected serum calcium (ACSC) at baseline and all-cause mortality within 30 days after the first admission, respectively. Multivariable logistic regression analysis was used to estimate the risk of 30-day mortality according to ACSC levels. Moreover, the potential presence of a non-linear relationship was evaluated using two-piecewise linear regression with a smoothing function and threshold level analysis. The stability of the results was evaluated by unadjusted and adjusted models.

Results: The result of multiple regression analysis showed that ACSC at baseline was positively associated with the incidence of 30-day mortality after adjusting for the potential confounders (age, gender, serum glucose, hypertension, atrial fibrillation/atrial flutter, renal insufficiency, heart failure, chronic obstructive pulmonary disease, pneumonia, paralysis, and aphasia) (OR = 2.43, 95% CI 1.43–4.12). When ACSC was translated into a categorical variable, the ORs and 95% CIs in the second to the fourth quartile vs. the first quartile were 1.23 (0.56, 2.69), 1.16 (0.51, 2.65), and 2.13 (1.04, 4.38), respectively (P for trend = 0.03). Moreover, the results of two-piecewise linear regression and curve-fitting revealed a linear relationship between ACSC and 30-day mortality.

Conclusion: ACSC is positively associated with 30-day mortality in IS patients, and the relationship between them is linear.

Introduction

Stroke can cause a low quality of life for patients and their families, as well as a great burden and loss for society due to high rates of disability and mortality (1). Ischemic stroke (IS), which is the main subtype of stroke, accounts for about 60–80% (1) of all stroke cases according to the latest evidence. Given this, early risk stratification after acute IS may contribute to improving clinical decision-making.

Calcium is the most abundant mineral in the human body (2), widely taking part in various crucial physiological processes including signal transduction, maintenance of the stability of the cell membrane, coagulation process, movement of the smooth muscle or skeletal muscle, and endocrine function (3, 4). Serum calcium level in a normal physiological situation is strictly controlled to remain within a narrow range (5). Moreover, dyscalcemia has been demonstrated to be related to the risk of cardiovascular and cerebrovascular diseases (6–8).

To date, a limited amount of studies have addressed the association between serum calcium levels and IS outcomes, with conflicting results (9–13). In these studies, both low (10) and high levels (12) of serum calcium have been reported to correlate with poor outcomes of IS. One study reported a U shape association between serum calcium levels and in-hospital all-cause mortality (11). Furthermore, Asian and North American patients were the main subjects in previous studies, which failed to consider European populations. However, not only do the incidence rate and morbidity of stroke vary in different populations (14), in addition to the calcium metabolism (15).

Serum calcium is susceptible to serum albumin levels (16) and albumin-corrected serum calcium (ACSC) calculated according to the classic formula (17) is increasingly used in place of serum calcium in many clinical studies (10–13). Therefore, this study was designed to assess the correlation between ACSC and 30-day mortality in IS patients based on a Norwegian retrospective cohort.