Association between serum calcium and in-hospital mortality in critical patients with multiple myeloma: a cohort study

Treatment Outcomes of Hypercalcemia of Malignancy Among Advanced Cancer Patients Attending Palliative Care Unit of a Tertiary Care Hospital in Bangladesh: An Observational Study

Background and Aim

Hypercalcemia is one of the most common complications of advanced malignancy. Treatment of hypercalcemia among advanced cancer patients often gives rise to complex ethical issues. This study aims to explore treatment outcomes of hypercalcemia among advanced cancer patients so that palliative care physicians can design cost-effective and efficient approaches to diagnosis and treatment for these patients.

Methods

This observational study was conducted among 31 advanced (stages III and IV) cancer patients diagnosed with hypercalcemia of malignancy admitted to the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Bangladesh, from June to December 2023. The patients were observed on the day of admission and followed up on 3rd and 7th day for assessment of their response to the received treatment. Chi-square test, Fisher's exact test, paired and unpaired t-tests were done to assess the treatment response and changes in the clinical characteristics of the patients.

Result

After 3 days of rehydration therapy, the mean serum calcium level decreased significantly from 12.43 ± 1.96 to 10.82 ± 2.07 after treatment, with a significant p-value of < 0.001. For the management of remaining hypercalcemic patients, intravenous bisphosphonates are used in conjunction with normal saline. There was a substantial decrease in the mean value of serum calcium level from 12.66 ± 1.91 to 10.27 ± 0.75 after treatment with normal saline and bisphosphonate on the 7th day. The majority of patients (64.5%) showed improvement following treatment. A smaller percentage (16.1%) remained hypercalcemic even after getting all treatments. Unfortunately, 19.4% died, possibly due to the progressive nature of the disease along with hypercalcemia.

Conclusion

Malignant hypercalcemia is a potentially fatal, undiagnosed, and undertreated complication of advanced malignancy. It is essential for palliative care physicians to identify hypercalcemia and develop comprehensive care plan to optimize the treatment outcomes.

Association between serum calcium and in-hospital mortality in critically ill atrial fibrillation patients from the MIMIC IV database

Thongprayoon et al. found in a study of 12,599 non-dialysis adult hospitalized patients that serum calcium (SC) disturbances affected more than half of the patients and were associated with increased in-hospital mortality. Similar impacts of SC disturbances on in-hospital mortality have been observed in patients with acute myocardial infarction and the general hospitalized population. Atrial fibrillation (AF), the most common arrhythmia in the intensive care unit (ICU), affects around 6% of critically ill patients. However, the significance of the relationship between SC levels and in-hospital mortality in these patients remains unclear. This study aimed to explore the correlation between SC levels and in-hospital mortality in ICU patients diagnosed with AF. Data from the MIMIC-IV database included 11,621 AF patients (average age 75.59 ± 11.74 years; 42.56% male), with an in-hospital mortality rate of 8.90%. A nonlinear relationship between SC levels and in-hospital mortality was observed. Effect sizes on either side of the inflection point were 0.79 (HR: 0.79, 95% CI 0.67-0.94, P = 0.006) and 1.12 (HR: 1.12, 95% CI 1.01-1.25, P = 0.029). Sensitivity analyses confirmed these results. SC levels around 8.56 mg/dL were associated with the lowest risk of in-hospital mortality, with risks increasing as SC levels deviated from this point. SC levels below this inflection point were linked to more pronounced clinical impacts. This finding has significant clinical implications for clinicians. Therefore, in the treatment of ICU patients with AF, clinicians should closely monitor SC levels, with a focus on maintaining them around 8.56 mg/dL.

Association between serum calcium levels and in-hospital mortality in sepsis: A retrospective cohort study

Background

This study examines serum calcium levels and in-hospital mortality in patients with sepsis, a subject with contradictory findings in the existing literature.

Methods

This retrospective cohort study utilized data from the MIMIC-IV database, focusing on adult patients diagnosed with sepsis between 2008 and 2019. The serum calcium levels were taken as the highest value within the first 24 h of Intensive Care Unit (ICU) admission. We performed Cox proportional hazards regression analyses in multivariable-adjusted models to investigate the association between serum calcium levels and in-hospital mortality. Restricted cubic spline functions were used to assess the nonlinear relationship, and threshold effect analysis was conducted to identify potential inflection points.

Results

A total of 18,546 patients with sepsis were included in the study, and an in-hospital mortality rate of 16.9 % (3,126 out of 18,546) was obtained. Furthermore, a U-shaped relationship was observed between serum calcium concentrations and in-hospital mortality, with the lowest point at approximately 8.23 mg/dL. Hazard ratios were calculated as 0.75 (95 % CI: 0.67-0.85, P < 0.001) on the left side and 1.10 (95 % CI: 1.04-1.16, P < 0.001) on the right side of the inflection point. Sensitivity analyses corroborated these results.

Conclusion

The research identified a U-shaped correlation between serum calcium concentrations and in-hospital mortality rates among patients with sepsis, underscoring the importance of serum calcium monitoring in this patient population upon hospital admission.

The relationship between red cell distribution width, serum calcium ratio, and in-hospital mortality among patients with acute respiratory failure: A retrospective cohort study of the MIMIC-IV database

To investigate the impact of RDW/CA (the ratio of red cell distribution width to calcium) on in-hospital mortality in patients with acute respiratory failure (ARF). This retrospective cohort study analyzed the data of 6981 ARF patients from the Medical Information Mart for Intensive Care (MIMIC-IV) database 2.0. Critically ill participants between 2008 and 2019 at the Beth Israel Deaconess Medical Center in Boston. The primary outcome of interest was in-hospital mortality. A Cox proportional hazards regression model was used to determine whether the RDW/CA ratio independently correlated with in-hospital mortality. The Kaplan-Meier method was used to plot the survival curves of the RDW/CA. Subgroup analyses were performed to measure the mortality across various subgroups. After adjusting for potential covariates, we found that a higher RDW/CA was associated with an increased risk of in-hospital mortality (HR = 1.17, 95% CI: 1.01-1.35, P = .0365) in ARF patients. A nonlinear relationship was observed between RDW/CA and in-hospital mortality, with an inflection point of 1.97. When RDW/CA ≥ 1.97 was positively correlated with in-hospital mortality in patients with ARF (HR = 1.554, 95% CI: 1.183-2.042, P = .0015). The Kaplan-Meier curve indicated the higher survival rates for RDW/CA < 1.97 and the lower for RDW/CA ≥ 1.97 after adjustment for age, gender, body mass index, and ethnicity. RDW/CA is an independent predictor of in-hospital mortality in patients with ARF. Furthermore, a nonlinear relationship was observed between RDW/CA and in-hospital mortality in patients with ARF.