Hospital-Acquired Serum Ionized Calcium Derangements and Their Associations with In-Hospital Mortality
Charat Thongprayoon,
Panupong Hansrivijit,
Tananchai Petnak,
Michael A. Mao,
Tarun Bathini,
Saraschandra Vallabhajosyula,
Ploypin Lertjitbanjong,
Fawad Qureshi,
Stephen B. Erickson,
Wisit Cheungpasitporn
Affiliations
Charat Thongprayoon
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
Panupong Hansrivijit
Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA 17101, USA
Tananchai Petnak
Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Michael A. Mao
Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA
Tarun Bathini
Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA
Saraschandra Vallabhajosyula
Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
Ploypin Lertjitbanjong
Division of Pulmonary, Critical Care and Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
Fawad Qureshi
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
Stephen B. Erickson
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
Wisit Cheungpasitporn
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
Background: The objective of this study was to report the incidence of in-hospital serum ionized calcium derangement and its impact on mortality. Methods: We included 12,599 non-dialytic adult patients hospitalized at a tertiary medical center from January 2009 to December 2013 with normal serum ionized calcium at admission and at least 2 in-hospital serum ionized calcium values. Using serum ionized calcium of 4.60–5.40 mg/dL as the normal reference range, in-hospital serum ionized calcium levels were categorized based on the presence of hypocalcemia and hypercalcemia in hospital. We performed logistic regression to assess the relationship of in-hospital serum ionized calcium derangement with mortality. Results: Fifty-four percent of patients developed new serum ionized calcium derangements: 42% had in-hospital hypocalcemia only, 4% had in-hospital hypercalcemia only, and 8% had both in-hospital hypocalcemia and hypercalcemia. In-hospital hypocalcemia only (OR 1.28; 95% CI 1.01–1.64), in-hospital hypercalcemia only (OR 1.64; 95% CI 1.02–2.68), and both in-hospital hypocalcemia and hypercalcemia (OR 1.73; 95% CI 1.14–2.62) were all significantly associated with increased in-hospital mortality, compared with persistently normal serum ionized calcium levels. Conclusions: In-hospital serum ionized calcium derangements affect more than half of hospitalized patients and are associated with increased in-hospital mortality.
