Hospital-Acquired Serum Ionized Calcium Derangements and Their Associations with In-Hospital Mortality

• Authors: Charat Thongprayoon, Mayo Clinic; Panupong Hansrivijit, University of Pittsburgh; Tananchai Petnak, Mahidol University; Michael A Mao, Mayo Clinic; Tarun Bathini, University of Arizona; Saraschandra Vallabhajosyula, Emory University; Ploypin Lertjitbanjong, University of Tennessee; Fawad Qureshi, Mayo Clinic; Stephen B. Erickson, Mayo Clinic; Wisit Cheungpasitporn, Mayo Clinic
• Journal Title: Medicines
• Volume: Volume 7, Number 11
• Publisher: MDPI | 2020-11-19
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3390/medicines7110070
• Subjects: Health Sciences, Nutrition; Health Sciences, Health Care Management
• Keywords: hypercalcemia; hypocalcemia; calcium; electrolytes; mortality; hospitalization

Abstract

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.