Deans' stroke musings: Association between serum calcium and in-hospital mortality in intensive care unit patients with cerebral infarction: a cohort study

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.

Monday, October 21, 2024

Association between serum calcium and in-hospital mortality in intensive care unit patients with cerebral infarction: a cohort study

So you found an association. WHAT THE FUCK NEEDS TO BE DONE TO PREVENT THE PROBLEMS? That is what good stroke research should be doing. This is useless for stroke recovery! I'd have the mentors and senior researchers fired for such crapola!

Association between serum calcium and in-hospital mortality in intensive care unit patients with cerebral infarction: a cohort study

$\r\nKaiwu Meng,$ Kaiwu Meng^1,2

Xiaoyang Lei¹

Dian He¹^*

¹Neurology Department, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
²Neurology Department, The People's Hospital of QianNan, Duyun, Guizhou, China

Background: The relationship between serum calcium levels and the prognosis of cerebral infarction remains controversial.

Purpose: This study aims to investigate the correlation between serum calcium levels and in-hospital mortality in critically ill patients with ischemic stroke admitted to the intensive care unit (ICU).

Methods: A retrospective cohort study was conducted using data from the MIMIC-IV database. Demographic and clinical data of all participants were collected including gender, age, hypertension, diabetes, myocardial infarction, heart failure, chronic obstructive pulmonary disease, hemoglobin, potassium, sodium, anion gap, platelets, white blood cells, glucose, creatinine, Glasgow coma score (GCS), IV-tPA administration (rt-PA), and mechanical thrombectomy (MT). The outcome measure was in-hospital death. Multivariable-adjusted logistic regression analysis, curve fitting, interaction analysis, and threshold effect analysis were employed to evaluate the relationship between serum calcium levels and in-hospital mortality among ICU patients with cerebral infarction.

Results: A total of 2,680 critically ill patients with cerebral infarction were enrolled, with a mean serum calcium level of 8.6 ± 0.8 mg/dL. The overall in-hospital mortality rate was 19.5%, where Group 1 (serum calcium < 8.0 mg/dL) had a mortality rate of 27.7%, Group 2 (serum calcium 8–9 mg/dL) had a rate of 19.8%, and Group 3 (serum calcium ≥ 9 mg/dL) had a rate of 13.9%. There was a non-linear, S-shaped relationship between serum calcium levels and in-hospital mortality. Serum calcium levels within the range of 7.70–9.50 mg/dL were found to be independently associated with increased in-hospital mortality in ICU patients with cerebral infarction. No significant interactions were detected in subgroup analyses, and the results of sensitivity analyses remained stable.

Conclusion: Serum calcium levels are independently associated with in-hospital mortality in critically ill patients with cerebral infarction in the ICU setting. Within the range of 7.70–9.50 mg/dL, lower serum calcium levels increase the risk of in-hospital death among these patients, emphasizing the importance of close monitoring by ICU physicians.

1 Introduction

Cerebral infarction has received worldwide attention due to its high incidence and mortality rates, as well as its potential to cause disability. In recent years, numerous biological markers associated with the prognosis of cerebral infarction have been investigated and confirmed, such as the triglyceride-glucose index and the stress hyperglycemia ratio (1, 2). However, the relationship between serum calcium levels and the prognosis of cerebral infarction remains controversial. In humans, serum calcium levels are maintained within a relatively narrow range through a series of intricate feedback regulatory mechanisms (3); calcium ions play crucial roles in various physiological processes, particularly in the nervous system, where they participate in the conduction of nerve impulses, influence neuronal excitability, and regulate neurotransmitter release, thereby affecting the transmission of neural signals. Prior research has suggested that lower calcium levels may be associated with poorer clinical outcomes in ischemic stroke patients (4–7). Some studies have also linked low serum calcium levels to hemorrhagic transformation following cerebral infarction (8, 9). A study involving 784 patients revealed a nonlinear relationship between serum calcium levels and the prognosis of ischemic stroke, indicating that both excessively low and high calcium concentrations can elevate the likelihood of adverse outcomes (10). Contradictory findings have been reported by other research as well (11–13). The current debate is whether serum calcium levels are positively or negatively associated with the prognosis of cerebral infarction. In light of this ongoing debate, we conducted a study using a large amount of high-quality data from the MIMIC IV database to clarify the association between serum calcium levels and in-hospital mortality in patients with acute stroke and to explore the optimal range of serum calcium concentrations to improve outcomes in this patient population.