Skip to main content

Advertisement

SpringerLink
Log in

Admission Serum Calcium Level as a Prognostic Marker for Intracerebral Hemorrhage

  • Original Article
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Background

Prognostic significance of serum calcium level in patients with intracerebral hemorrhage is not well studied. The aim of the study was to identify if a relationship between admission serum calcium level and prognosis exists in patients with intracerebral hemorrhage.

Methods

A total of 1262 confirmed intracerebral hemorrhage patients were included. Demographic data, medical history, medicine history, laboratory data, imaging data, clinical score, and progress note were collected from their medical records. All images of head computed tomography were reanalyzed. Ninety-day prognosis was recorded, and poor outcome was defined as death or major disability caused by intracerebral hemorrhage.

Results

During the 90-day follow-up period, 504 patients died and 226 patients suffered from major disability. Death and major disability were combined as poor prognosis. The remaining 532 patients showed good prognosis. Admission serum calcium level was lower in the patients with poor prognosis than in the patients with good prognosis (2.41 ± 0.23 mmol/l, 2.55 ± 0.26 mmol/l, P < 0.001). Admission INR and hematoma volume were higher in the patients with poor prognosis than in the patients with good prognosis (INR: 1.74 ± 0.29, 1.70 ± 0.29, P = 0.029; hematoma volume: 11.6 ± 4.4 ml, 10.7 ± 4.1 ml, P < 0.001). There was no difference in admission APTT level between the two prognosis groups (28.4 ± 5.6 s, 27.8 ± 5.4 s, P = 0.056). A multivariate COX regression analysis reported that admission serum calcium level ≤ 2.41 mmol/l was associated with the increased risk of poor prognosis (death or major disability) in the patients (HR 1.45, 95% CI 1.32–1.60). In addition, there was a significant linear association of serum calcium level with coagulation function markers and hematoma volume on admission (APTT: r = − 0.091, P = 0.001; INR: r = − 0.063, P = 0.025; hematoma volume: r = −0.108, P < 0.001).

Conclusions

Admission serum calcium level might be a prognostic marker for intracerebral hemorrhage. Potential mechanism involved calcium-induced coagulation function abnormality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Keep RF, Hua Y, Xi G. Intracerebral haemorrhage: mechanisms of injury and therapeutic targets. Lancet Neurol. 2012;11:720–31.

    Article  CAS  PubMed  Google Scholar 

  2. Caceres JA, Goldstein JN. Intracranial hemorrhage. Emerg Med Clin N Am. 2012;30:771–94.

    Article  Google Scholar 

  3. Navi BB, Parikh NS, Lerario MP, et al. Risk of intracerebral hemorrhage after emergency department discharges for hypertension. J Stroke Cerebrovasc Dis. 2016;25:1683–7.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Rojo Martínez E, Guerrero Peral AL, Herrero Velázquez S, Núñez García J. Recurrent intracerebral haemorrhage in primary amyloidosis. Neurologia. 2013;28:252–5.

    Article  PubMed  Google Scholar 

  5. Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke. 1993;24:987–93.

    Article  CAS  Google Scholar 

  6. Dowlatshahi D, Demchuk AM, Flaherty ML, Ali M, Lyden PL, Smith EE. Defining hematoma expansion in intracerebral hemorrhage: relationship with patient outcomes. Neurology. 2011;76:1238–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Inoue Y, Miyashita F, Toyoda K, Minematsu K. Low serum calcium levels contribute to larger hematoma volume in acute intracerebral hemorrhage. Stroke. 2013;44:2004–6.

    Article  CAS  PubMed  Google Scholar 

  8. Guo Y, Yan S, Zhang S, et al. Lower serum calcium level is associated with hemorrhagic transformation after thrombolysis. Stroke. 2015;46:1359–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Morotti A, Charidimou A, Phuah CL, et al. Association between serum calcium level and extent of bleeding in patients with intracerebral hemorrhage. JAMA Neurol. 2016;73:1285–90.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Jackson SP, Nesbitt WS, Kulkarni S. Signaling events underlying thrombus formation. J Thromb Haemost. 2003;1:1602–12.

    Article  CAS  PubMed  Google Scholar 

  11. Triplett DA. Coagulation and bleeding disorders: review and update. Clin Chem. 2000;46:1260–9.

    CAS  PubMed  Google Scholar 

  12. Mupanomunda MM, Ishioka N, Bukoski RD. Interstitial Ca2+undergoes dynamic changes sufficient to stimulate nerve-dependent Ca2+-induced relaxation. Am J Physiol. 1999;276:H1035–42.

    CAS  PubMed  Google Scholar 

  13. Ohwaki K, Yano E, Nagashima H, Hirata M, Nakagomi T, Tamura A. Blood pressure management in acute intracerebral hemorrhage: relationship between elevated blood pressure and hematoma enlargement. Stroke. 2004;35:1364–7.

    Article  PubMed  Google Scholar 

  14. Barlow P. A practical review of the Glasgow Coma Scale and Score. Surgeon. 2012;10:114–9.

    Article  PubMed  Google Scholar 

  15. Odderson IR. The National Institutes of Health Stroke Scale and its importance in acute stroke management. Phys Med Rehabil Clin N Am. 1999;10:787–800.

    Article  CAS  PubMed  Google Scholar 

  16. Quinn TJ, Dawson J, Walters MR, Lees KR. Reliability of the modified Rankin Scale: a systematic review. Stroke. 2009;40:3393–5.

    Article  PubMed  Google Scholar 

  17. Liu J, Wang D, Xiong Y, et al. A cohort study of relationship between serum calcium levels and cerebral microbleeds (CMBs) in ischemic stroke patients with AF and/or RHD. Medicine (Baltimore). 2016;95:e4033.

    Article  Google Scholar 

  18. Wellman GC, Nathan DJ, Saundry CM, et al. Ca2+ sparks and their function in human cerebral arteries. Stroke. 2002;33:802–8.

    Article  CAS  PubMed  Google Scholar 

  19. Llach F, Weidmann P, Reinhart R, Maxwell MH, Coburn JW, Massry SG. Effect of acute and long-standing hypocalcemia on blood pressure and plasma renin activity in man. J Clin Endocrinol Metab. 1974;38:841–7.

    Article  CAS  PubMed  Google Scholar 

  20. Johari V, Loke C. Brief overview of the coagulation cascade. Dis Mon. 2012;58:421–3.

    Article  PubMed  Google Scholar 

  21. Borah M, Dhar S, Gogoi DM, Ruram AA. Association of serum calcium levels with infarct size in acute ischemic stroke: observations from Northeast India. J Neurosci Rural Pract. 2016;7:S41–5.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The study was supported by the Natural Science Foundation of China (81560201).The study was supported by the Doctor Foundation of Guizhou Provincial People’s Hospital (GZSYBS[2015]03).

Author information

Authors and Affiliations

  1. Department of General Medical, the Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China

    Li Tu

  2. Department of Emergency, Guizhou Provincial People’s Hospital, No. 83, Zhongshan East Road, Guiyang, 550002, Guizhou Province, People’s Republic of China

    Xiujuan Liu, Tian Li, Xiulin Yang, Yipin Ren, Qian Zhang, Huan Yao, Xiang Qu & Jinyong Tian

  3. Zunyi Medical University, Zunyi, Guizhou Province, People’s Republic of China

    Tian Li & Qian Wang

  4. Department of Neurology, Guizhou Provincial People’s Hospital, Guiyang, 550002, Guizhou Province, People’s Republic of China

    Tian Tian

Authors
  1. Li Tu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiujuan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tian Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiulin Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yipin Ren
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qian Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Huan Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Xiang Qu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Qian Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tian Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jinyong Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LT, XL, TL, XY, YR, QZ, HY, XQ, Q W, TT, and JT were involved in study concept and design, acquisition of data, analysis and interpretation of data, and preparation of the manuscript.

Corresponding author

Correspondence to Jinyong Tian.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tu, L., Liu, X., Li, T. et al. Admission Serum Calcium Level as a Prognostic Marker for Intracerebral Hemorrhage. Neurocrit Care 30, 81–87 (2019). https://doi.org/10.1007/s12028-018-0574-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-018-0574-0

Keywords

Search

Navigation