Idiopathic Hypercalcemia in Decompensated Cirrhosis: Reexploring an Entity in Oblivion

Predictors of mortality in hypercalcemia of advanced chronic liver disease

OBJECTIVE

Hypercalcemia is sometimes observed in patients with cirrhosis, but very little is known about the epidemiology of patients with hypercalcemia of chronic liver disease (HCLD) or how its presence may modulate overall mortality risk. We assessed for associations between clinical and laboratory characteristics of HCLD patients with 90-day mortality.

METHODS

A systematic search of the medical record at our institution over a 10-year period was performed to retrospectively identify subjects with HCLD during inpatient admission. Univariate and multivariate regression was performed to detect risk factors for all-cause 90-day mortality.

RESULTS

38 subjects with HCLD were identified using stringent inclusion and exclusion criteria to exclude individuals with other secondary causes of hypercalcemia. 35 subjects had 90-day vital status available, which revealed 40% mortality. MELD-Na score and duration of inpatient hypercalcemia were positively associated with mortality with respective odds ratios of 1.23 (95% CI 1.06-3.23) and 1.24 (95% CI 1.04-1.49) in a univariate model and 1.30 (95% CI 1.04-1.62) and 1.33 (95% CI 1.04-1.71) in a multivariate regression. Admission and peak serum calcium were not associated with mortality. Only 6 subjects received bisphosphonate or calcitonin during their admission, limiting our ability to assess the impact of treatment on outcomes.

CONCLUSIONS

In patients admitted to the hospital with HCLD, duration of hypercalcemia was positively associated with 90-day mortality, providing a potential interventional target to reduce mortality in this high-risk population. Studies to validate the utility of treating hypercalcemia are required.