Correlation between admission blood calcium level and the prognosis of patients with hypertensive intracerebral hemorrhage

doi:10.3969/j.issn.1673-8640.2022.05.005

Abstract

Abstract: Objective To investigate the correlation between admission blood calcium level and 30 d mortality rate and 6-month functional outcome in patients with hypertensive intracerebral hemorrhage. Methods The data of patient age,sex,complications,the National Institutes of Health Stroke Scale （NIHSS）,intracranial hematoma volume and location and clinical laboratory results from 107 patients with hypertensive intracerebral hemorrhage were analyzed retrospectively. The patients were classified into >2.75 mmol/L group（15 cases）,2.25-2.75 mmol/L group（63 cases）and <2.25 mmol/L group（29 cases）. A modified Rankin Scale（mRS）>2 denoted poor functional outcome at 6 months. The correlations between calcium level,30 d mortality rate and 6-month functional outcome in hypertensive intracerebral hemorrhage was evaluated by Logistic regression analysis. Receiver operating characteristic （ROC） curve was used to distinguish hypertensive intracerebral hemorrhage patients with favorable and unfavorable functional outcome. Results Compared with >2.75 mmol/L group and 2.25-2.75 mmol/L group,the patients in <2.25 mmol/L group were presented with significantly larger intracranial hematoma（P<0.05）,higher NIHSS score and mRS score（P<0.05）,and more early hematoma enlargement 30 d mortality cases（P<0.05）and there was no statistical significance among the 3 groups（P>0.05）. Calcium level at admission predicted 30 d mortality and 6-month functional outcome with areas under curves（AUC） of 0.74 and 0.71,respectively. Calcium levels at admission were correlated with hematoma volume and early hematoma enlargement [odds ratio（OR）=0.24,95% confidence interval（CI）0.11-0.69;OR=0.15,95%CI 0.08-0.87,respectively]. The OR of 30 d mortality and poor functional outcome at 6 months of <2.25 mmol/L group were 1.12 and 1.39 as compared with >2.75 mmol/L group. Conclusions A low calcium level at admission is correlated with 30 d mortality and poor 6-month functional outcome for patients with hypertensive intracerebral hemorrhage. Blood calcium level determination may conduce to patients' prognosis identification.

Key words: Calcium, Hypertensive intracerebral hemorrhage, Prognosis

HUANG Liying, SAI Fangfang, ZHANG Kebei, MENG Chao. Correlation between admission blood calcium level and the prognosis of patients with hypertensive intracerebral hemorrhage[J]. Laboratory Medicine, 2022, 37(5): 423-428.

Figures/Tables 5

References 18

[1]	Writing Group Members, LLOYD-JONES D, ADAMS R J, et al. Heart disease and stroke statistics--2010 update:a report from the American Heart Association[J]. Circulation, 2010, 121(7):e46-e215.
[2]	ROSAMOND W D, FOLSOM A R, CHAMBLESS L E, et al. Stroke incidence and survival among middle-aged adults:9-year follow-up of the Atherosclerosis Risk in Communities(ARIC) cohort[J]. Stroke, 1999, 30(4):736-743. DOI URL
[3]	CAO D, LI Q, FU P, et al. Early hematoma enlargement in primary intracerebral hemorrhage[J]. Curr Drug Targets, 2017, 18(12):1345-1348.
[4]	钟永盛, 陈伟强, 蔡世荣, 等. 自发性脑出血早期血清钙离子浓度及其变化趋势的临床研究[J]. 数理医药学杂志, 2017, 30(12):1760-1762.
[5]	马潞, 李浩, 吴波, 等. 自发性脑出血诊断治疗中国多学科专家共识[J]. 中华急诊医学杂志, 2015, 24(12):1319-1323.
[6]	INOUE Y, MIYASHITA F, TOYODA K, et al. Low serum calcium levels contribute to larger hematoma volume in acute intracerebral hemorrhage[J]. Stroke, 2013, 44(7):2004-2006. DOI URL
[7]	LIU J, YANG H, YU B. The correlation between blood calcium level,hematoma volume,stroke severity and prognosis in patients with acute cerebral hemorrhage[J]. Eur Rev Med Pharmacol Sci, 2016, 20(19):4119-4123.
[8]	MOROTTI A, CHARIDIMOU A, PHUAH C L, et al. Association between serum calcium level and extent of bleeding in patients with intracerebral hemorrhage[J]. JAMA Neurol, 2016, 73(11):1285-1290. DOI URL
[9]	SHAH Q A, EZZEDDINE M A, QURESHI A I. Acute hypertension in intracerebral hemorrhage:pathophysiology and treatment[J]. J Neurol Sci, 2007, 261(1-2):74-79. DOI URL
[10]	BROWN R C, DAVIS T P. Calcium modulation of adherens and tight junction function:a potential mechanism for blood-brain barrier disruption after stroke[J]. Stroke, 2002, 33(6):1706-1711. DOI URL
[11]	LIN K I, CHATTOPADHYAY N, BAI M, et al. Elevated extracellular calcium can prevent apoptosis via the calcium-sensing receptor[J]. Biochem Biophys Res Commun, 1998, 249(2):325-331. DOI URL
[12]	BICKLER P E, FAHLMAN C S. Moderate increases in intracellular calcium activate neuroprotective signals in hippocampal neurons[J]. Neuroscience, 2004, 127(3):673-683. DOI URL
[13]	PEULER J D, SCHELPER R L. Partial protection from salt-induced stroke and mortality by high oral calcium in hypertensive rats[J]. Stroke, 1992, 23(4):532-538. DOI URL
[14]	MA T Y, TRAN D, HOA N, et al. Mechanism of extracellular calcium regulation of intestinal epithelial tight junction permeability:role of cytoskeletal involvement[J]. Microsc Res Tech, 2000, 51(2):156-168. DOI URL
[15]	YOU S, HAN Q, XU J, et al. Serum calcium and phosphate levels and short- and long-term outcomes in acute intracerebral hemorrhage patients[J]. J Stroke Cerebrovasc Dis, 2016, 25(4):914-920. DOI URL
[16]	D'ERASMO E, PISANI D, ROMAGNOLI S, et al. Acute serum calcium changes in transient ischemic attack and cerebral infarction[J]. J Med, 1998, 29(5-6):331-337.
[17]	ISO H, STAMPFER M J, MANSON J E, et al. Prospective study of calcium,potassium,and magnesium intake and risk of stroke in women[J]. Stroke, 1999, 30(9):1772-1779. DOI URL
[18]	UMESAWA M, ISO H, DATE C, et al. Dietary intake of calcium in relation to mortality from cardiovascular disease:the JACC Study[J]. Stroke, 2006, 37(1):20-26. DOI URL

组别	例数	年龄/岁	性别		糖尿病史/[例（%）]	吸烟史/ [例（%）]	血肿体积/mL	NIHSS评分/分
组别	例数	年龄/岁	男性/例	女性/例	糖尿病史/[例（%）]	吸烟史/ [例（%）]	血肿体积/mL	NIHSS评分/分
血总钙<2.25 mmol/L组	29	67.52±7.38	16	13	14（48.28）	18（62.07）	24.17±9.96	8.97±2.69
血总钙2.25~2.75 mmol/L组	63	65.59±5.37	41	22	27（42.86）	44（69.84）	19.04±9.04	7.02±1.82
血总钙>2.75 mmol/L组	15	68.00±6.34	10	5	6（40.00）	11（73.33）	17.15±7.25	7.93±3.01
统计值		1.31	0.10		0.35	0.76	4.13	7.45
P值		0.28	0.62		0.84	0.68	0.02	0.001

组别	例数	年龄/岁	性别		糖尿病史/[例（%）]	吸烟史/ [例（%）]	血肿体积/mL	NIHSS评分/分
组别	例数	年龄/岁	男性/例	女性/例	糖尿病史/[例（%）]	吸烟史/ [例（%）]	血肿体积/mL	NIHSS评分/分
血总钙<2.25 mmol/L组	29	67.52±7.38	16	13	14（48.28）	18（62.07）	24.17±9.96	8.97±2.69
血总钙2.25~2.75 mmol/L组	63	65.59±5.37	41	22	27（42.86）	44（69.84）	19.04±9.04	7.02±1.82
血总钙>2.75 mmol/L组	15	68.00±6.34	10	5	6（40.00）	11（73.33）	17.15±7.25	7.93±3.01
统计值		1.31	0.10		0.35	0.76	4.13	7.45
P值		0.28	0.62		0.84	0.68	0.02	0.001

项目	单因素分析			多因素分析
项目	OR值（95%CI）	标准误	P值	OR值（95%CI）	标准误	P值
血总钙	0.14（0.11~0.31）	2.60	0.007	0.24（0.11~0.69）	0.38	0.01
APTT				0.07（0.02~1.12）	0.32	0.44
INR				0.12（0.08~1.23）	0.18	0.23
血小板计数				0.16（0.05~0.33）	0.04	0.01

项目	单因素分析			多因素分析
项目	OR值（95%CI）	标准误	P值	OR值（95%CI）	标准误	P值
血总钙	0.14（0.11~0.31）	2.60	0.007	0.24（0.11~0.69）	0.38	0.01
APTT				0.07（0.02~1.12）	0.32	0.44
INR				0.12（0.08~1.23）	0.18	0.23
血小板计数				0.16（0.05~0.33）	0.04	0.01

项目	单因素分析			多因素分析
项目	OR值（95%CI）	标准误	P值	OR值（95%CI）	标准误	P值
血总钙	0.15（0.08~0.31）	0.68	0.005	0.15（0.08~0.87）	0.70	0.006
APTT				1.03（0.56~2.03）	0.08	0.850
INR				1.25（0.65~1.89）	1.39	0.870
血小板计数				1.00（0.83~1.32）	0.01	0.850