Serum calcium as prognosticator in ischemic stroke.
OBJECTIVE
Calcium (Ca(2+)) plays a role in the cellular and molecular pathways of ischemic neuronal death. We evaluated the impact of both early and delayed Ca(2+) levels on clinical outcomes from acute ischemic stroke.


METHODS
The relations between blood calcium level obtained early (<4.5 hours), and delayed (72 to 96 hours) after ischemic stroke onset versus clinical outcomes were analyzed in 826 subjects enrolled in an international trial in the Virtual International Stroke Trials Archive. Subjects were categorized into Ca(2+) quartiles. Outcome measures analyzed included baseline and 72- to 96-hour stroke severity, as well as 3-month functional and global disability scales. The independent effect of calcium on outcome was evaluated by median and logistic regression analysis.


RESULTS
Six hundred and fifty-nine (80%) of the trial subjects had complete baseline data including Ca(2+) levels. Bivariately, the highest delayed Ca(2+) quartile (versus lowest) was associated with lesser stroke severity and better 3-month functional and independence scale outcomes (all P<0.001), but no significant outcome differences were noted among early Ca(2+) levels. In multivariable analysis, delayed Ca(2+) in the highest quartile (versus lowest quartile) was associated with greater 3-month independence score on the Barthel Index scale (76.9 versus 55.4, P=0.006). No other significant outcome differences were noted between highest and lowest quartiles for both early and delayed Ca(2+) quartiles.


CONCLUSIONS
Elevated 72- to 96-hour serum Ca(2+) levels independently predict greater independence 3 months after ischemic stroke, but very early serum Ca(2+) appear not to have any prognostic significance.
Ovbiagele
Bruce
B
Stroke Center and Department of Neurology, University of California at Los Angeles Medical Center, 710 Westwood Plaza, Los Angeles, CA 90095, USA. Ovibes@mednet.ucla.edu
Starkman
Sidney
S
Teal
Philip
P
Lyden
Patrick
P
Kaste
Markku
M
Davis
Stephen M
SM
Hacke
Werner
W
Fierus
Monika
M
Saver
Jeffrey L
JL
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis* / Q000378:metabolism*; D002118:Calcium / Q000097:blood*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D020521:Stroke / Q000175:diagnosis* / Q000378:metabolism*
D002118:Calcium