title: Serum calcium levels and long-term mortality in patients with acute stroke.
abstract: BACKGROUND
  Calcium concentrations in serum are maintained within an exquisitely narrow range. Our aim was to examine the association between serum calcium and albumin-adjusted calcium (calcium(adj)) levels and stroke outcome in a cohort of unselected patients with acute stroke.
  
  
  METHODS
  Consecutive patients hospitalized due to acute stroke (ischemic or intracerebral hemorrhage) throughout a large medical center were systematically assessed and followed for 1 year. Baseline total calcium and calcium(adj) levels were collapsed into groups of low (<8.6 mg/dl), normal (8.7-9.9 mg/dl) and high (>10 mg/dl) levels and linear and quadratic relations with outcome were examined.
  
  
  RESULTS
  Among 784 patients (mean age 70.7 ± 12.5 years, 42.5% females), the mean ± SD total calcium level was 9.3 ± 0.6 mg/dl. For total calcium, the adjusted hazard ratio (HR) for all-cause death over 1 year was 1.83 [95% confidence interval (CI) 1.22-2.75] among patients with low versus normal levels. For calcium(adj), the adjusted HR for all-cause death among women was over 3-fold higher among patients with high calcium(adj) levels versus those with normal levels (3.31; 95% CI 1.70-6.46), while no such associations were observed among men. In models developed to estimate the linear and quadratic relations, each unit increment in total calcium squared was associated with an increased adjusted HR of all-cause death over 1 year (p = 0.02) confirming nonlinear associations, and each unit increment in calcium(adj) squared was associated with an increased adjusted HR of all-cause death over 1 year among women (p < 0.001) but not among men (p = 0.70).
  
  
  CONCLUSIONS
  Serum calcium concentrations are a marker of mortality in acute stroke patients, but the associations are not linear, increasing at both extremes of calcium levels. Our findings suggest that long-term survival is optimal in a distinct range of serum calcium levels.
authors.affiliation: Stroke Center, Department of Neurology, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Shmuel A
authors.initials: SA
authors.lastname: Appel
authors.forename: Noa
authors.initials: N
authors.lastname: Molshatzki
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Schwammenthal
authors.forename: Oleg
authors.initials: O
authors.lastname: Merzeliak
authors.forename: Maya
authors.initials: M
authors.lastname: Toashi
authors.forename: Ben-Ami
authors.initials: BA
authors.lastname: Sela
authors.forename: David
authors.initials: D
authors.lastname: Tanne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood*; D016009:Chi-Square Distribution; D005260:Female; D006760:Hospitalization; D006801:Humans; D007557:Israel; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011485:Protein Binding; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index; D020521:Stroke / Q000097:blood* / Q000401:mortality*; D013997:Time Factors
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; D002118:Calcium