Calcium Disorders in the Emergency Department: Independent Risk Factors for Mortality

• Published in: PloS one Vol. 10; no. 7; p. e0132788
• Main Authors: Sauter, Thomas C, Lindner, Gregor, Ahmad, Sufian S, Leichtle, Alexander Benedikt, Fiedler, Georg-Martin, Exadaktylos, Aristomenis K, Haider, Dominik G
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.07.2015; Public Library of Science (PLoS)
• Subjects: Abnormalities; Calcium; Calcium - metabolism; Chlorides - metabolism; Creatinine; Creatinine - metabolism; Cross-Sectional Studies; Disorders; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Emergency services; Female; Heart attacks; Heart failure; Hospital Mortality; Hospitals; Humans; Hypercalcemia; Hypercalcemia - complications; Hypercalcemia - metabolism; Hypocalcemia; Hypocalcemia - complications; Hypocalcemia - metabolism; Intensive care; Intensive Care Units; Kidney diseases; Laboratories; Length of Stay; Magnesium; Magnesium - metabolism; Male; Medicine; Middle Aged; Minority & ethnic groups; Morbidity; Mortality; Patients; Phosphates; Potassium; Potassium - metabolism; Proportional Hazards Models; Regression analysis; Regression models; Risk analysis; Risk Factors; Serum levels; Sodium; Sodium - metabolism; Subgroups; Switzerland; Trauma; Traumatic brain injury; Switzerland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0132788

Calcium disorders are common in both intensive care units and in patients with chronic kidney disease and are associated with increased morbidity and mortality. It is unknown whether calcium abnormalities in unselected emergency department admissions have an impact on in-hospital mortality. This cross-sectional analysis included all admissions to the Emergency Department at the Inselspital Bern, Switzerland from 2010 to 2011. For hyper- and hypocalcaemic patients with a Mann-Whitney U-test, the differences between subgroups divided by age, length of hospital stay, creatinine, sodium, chloride, phosphate, potassium and magnesium were compared. Associations between calcium disorders and 28-day in-hospital mortality were assessed using the Cox proportional hazard regression model. 8,270 patients with calcium measurements were included in our study. Overall 264 (3.2%) patients died. 150 patients (6.13%) with hypocalcaemia and 7 patients with hypercalcaemia (6.19%) died, in contrast to 104 normocalcaemic patients (1.82%). In univariate analysis, calcium serum levels were associated with sex, mortality and pre-existing diuretic therapy (all p<0.05). In multivariate Cox regression analysis, hypocalcaemia and hypercalcaemia were independent risk factors for mortality (HR 2.00 and HR 1.88, respectively; both p<0.01). Both hypocalcaemia and hypercalcaemia are associated with increased 28-day in-hospital mortality in unselected emergency department admissions.