title: Serum calcium as prognosticator in ischemic stroke.
abstract: 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.
authors.affiliation: 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
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.forename: Sidney
authors.initials: S
authors.lastname: Starkman
authors.forename: Philip
authors.initials: P
authors.lastname: Teal
authors.forename: Patrick
authors.initials: P
authors.lastname: Lyden
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Davis
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
authors.forename: Monika
authors.initials: M
authors.lastname: Fierus
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
mesh_terms: 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*
chemical_list: D002118:Calcium