DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20151425

Correlation of serum calcium levels with severity and functional outcome in acute ischemic stroke patients

Abha Gupta, Umesh Dubey, Arvind Kumar, Shailesh Singh

Abstract


Background: The objective of the study was to study the role of serum calcium levels in accessing the severity and functional outcome in the patients of acute ischemic stroke.

Methods: The study included a total of 50 patients of acute ischemic stroke in the age group of 20 to 80 years. The patients were divided into four quartiles as per their serum albumin corrected levels measured during 24 ton 48 hours of incidence of ischemic stroke. The stroke severity was accessed by using National Institutes of Health (NIH) stroke scale and the functional outcome at the time of discharge and after three months of follow up by using modified Rankin scale (mRS). The results were analyzed by using appropriate statistical test.

Results: We found that the patients those in higher calcium quartiles (Q3,Q4) had significantly lesser 24-48 hrs stroke severity as compared to those in lower calcium quartiles (Q1,Q2) i.e. in 72.73% in Q3, and 42.86% in Q4 were in mild NIH scale group as compared to 7.69% in Q2 and 0% in Q1. At the time of discharge and at three months follow up functional outcome was significantly better in higher calcium quartile group when compared to lower quartile (>3 mRS score suggestive of poor outcome in 91.66% of Q1, 76.93% in Q2, 27.27% in Q3 and 7.14% in Q4 at the time of discharge and 83.32% in Q1, 76.93 in Q2, 27.27% in Q3 and 7.14% in Q4 at three months of follow up). The correlation analysis showed that this association was statistically significant (p-value <0.01).

Conclusions: we conclude that 24 -48 hours calcium levels have strong correlation with severity and functional outcome in acute ischemic stroke patients and hence it can be taken as a marker of severity and prognostic factor in these patients.

 


Keywords


Serum calcium, Acute ischemic stroke, Prognostic factor

Full Text:

PDF

References


Iso H, Stampfer MJ, Manson JE, Rexrode K, Hennekens CH, Colditz GA, et al. Prospective study of calcium, potassium, and magnesium intake and risk of stroke in women. Stroke. 1999;30:1772–9.

Modified Rankin scale, internet stroke centre (Internet). 2011(updated 2011; cited 2008 sep 19). Available from: http://www.strokecentre.org/ trials/scales/ tarkin.html.

Chernow B, Zaloga G, McFadden E, Clapper M, Kotler M, Barton M, et al. Hypocalcemia in critically ill patients. Critical Care Medicine. 1982;10:848–51.

D' Erasmo E, Pisani D, Romagnoli S, Ragnoa, Acca M. Acute Serum Calcium Changes in transient ischemic attack and cerebral infarction. J. Med. 1998;29(5-6):331-7.

Frankel M, Morgenstern LB, Kwiatkowski T, Lu M, Tilley BC, Broderick JP, et al. Predicting prognosis after stroke: a placebo group analysis from the National Institute of Neurological Disorders and Stroke rt-PA Stroke Trial. Neurology. 2000;55:952-9.

Kumar C, Sree Chitra Tirunal Institute for Medical Sciences and Technology. What is calcium, and its functions in human body? (Internet) 1998 (1998 nov 3; cited 1998 oct 9). Available from: http://www.madsci.org/posts/archives/1998 11/910107388.Bc.r.html.

Siesjo B. Cerebral circulation and metabolism. J Neurosurgery. 1984 May;60(5):883-908.

Carlstedt F, Lind L, Rastad J, Stjernstrom H, Wide L, Ljunghall S. Parathyroid hormone and ionized calcium levels are related to the severity of illness and survival in critically ill patients. European Journal of Clinical Investigation. 1998;28:898 –903.

NIH Stroke Scale (NIHSS), internet stroke centre (Internet). 2011(updated 2011;cited 2008 sep 19). Available from: http://www. strokecentre.org /trials/scales/nihss.html.

The Barthel Index, internet stroke centre (Internet). 2011(updated 2011;cited 2008 sep 19). Available from :http://www.strokecentre. org/ trials.scales/barthel.pdf.

Ovbiagele B, Liebeskind DS, Starkman S, Sanossian N, Kim D, Razinia T, et al. Are elevated admission calcium levels associated with better outcomes after ischemic stroke? Neurology. 2006;67:170–3.

Clase C, Norman GL, Beecroft ML, Churchill DN. Albumin-corrected calcium and ionized calcium in stable haemodialysis patients. Nephrology Dialysis Transplantation. 2000;15:1841–6.

Buck Brian H, Liebeskind David S, Saver Jeffrey L, Bang Oh Young, Starkman Sidney, Ali Latisha K, et al. Association of higher serum calcium levels with smaller infarct volumes in acute ischemic stroke. Archives of Neurology. 2007;64(9):1287-91.

Kristian T, Siesjo BK. Calcium in ischemic cell death. Stroke. 1998;29:705–18.

Ovbiagele B, Starkman S, Teal P, Lyden P, Kasti M, Davis SM, et al. and on behalf of the Vista Investigators. Serum calcium as prognostication in ischemic stroke. Stroke. 2008;39(8):2231-6.