title: Elevated calcium after acute ischemic stroke: association with a poor short-term outcome and long-term mortality.
abstract: OBJECTIVE
  An elevated intracellular calcium level is known to be a major initiator and activator of ischemic cell death pathway; however, in recent studies, elevated serum calcium levels have been associated with better clinical outcomes and smaller cerebral infarct volumes. The pathophysiological role played by calcium in ischemic stroke is largely unknown.
  
  
  METHODS
  Acute stroke patients from a prospective stroke registry, consecutively admitted during October 2002-September 2008, were included. Significant associations between the modified Rankin scale distribution at discharge and serum calcium or albumin-corrected calcium were identified using ordinal logistic regression analysis. Cox proportional hazard models were used for survival analysis.
  
  
  RESULTS
  Mean serum calcium and albumin-corrected calcium levels of the 1,915 participants on admission were 8.97±0.58 mg/dL and 9.07±0.49 mg/dL, respectively. Second [adjusted odds ratio 1.32 (95% confidence interval 1.07-1.61)] and third [1.24 (1.01-1.53)] tertiles of serum calcium level and the third [1.24 (1.01-1.53)] tertile of albumin-corrected calcium level were found to be independent risk factors for a poor discharge outcome. Significant relationships were observed with serum calcium [1.19 (1.03-1.38)] and albumin-corrected calcium [1.21(1.01-1.44)] as linear variables. However, only albumin-corrected calcium was associated with long-term mortality, third tertile [adjusted hazard ratio 1.40 (1.07-1.83)], and increase by 1 mg/dL [1.46 (1.16-1.84)].
  
  
  CONCLUSIONS
  Elevated albumin-corrected serum calcium levels are associated with a poorer short-term outcome and greater risk of long-term mortality after acute ischemic stroke.
authors.affiliation: Department of Neurology and the CRCS, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jong-Won
authors.initials: JW
authors.lastname: Chung
authors.affiliation: Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Wi-Sun
authors.initials: WS
authors.lastname: Ryu
authors.affiliation: Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Beom Joon
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Department of Neurology and the CRCS, Seoul National University Hospital, and Neuroscience Research Institute, College of Medicine, Seoul National University, Seoul, Korea.
authors.forename: Byung-Woo
authors.initials: BW
authors.lastname: Yoon
keywords: Calcium; Cerebral infarction; Patient outcome assessment