Association of Hypocalcemia and Mean Arterial Pressure With Patient Outcome in ICU.

IF 7.7 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Medicine Pub Date : 2025-02-27 DOI:10.1097/CCM.0000000000006602

Fang-Yuan Li, Yan Chen, Xiang Zhou, Long-Xiang Su, Yun Long, Li Weng, Bin Du

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引用次数: 0

Abstract

Objectives: We aimed to verify the relationship between hypocalcemia in the first 24 hours of ICU admission and mortality, we also hypothesized that blood pressure and blood pressure reactivity are associated with ionized calcium (iCa) and might have mediation effects in the iCa-mortality association.

Design: Retrospective, observational study.

Setting: ICUs in a general hospital.

Patients: Nonhypercalcemia adult patients were divided into two groups based on mean iCa within the first 24 hours after ICU admission using a cutoff of 1.1 mmol/L.

Interventions: None.

Measurements and main results: A total of 4947 patients from Peking Union Medical College Hospital between January 2013 and December 2022 were included in the study, with 2160 (43.7%) suffering from hypocalcemia. Overall, the median (interquartile range) age was 61 years (49-71 yr), with 2824 (57.1%) being female. Time-weighted average mean arterial pressure (TWA-MAP) above 0 and 65 mm Hg, respectively, during the first 24 hours were used to analyze the MAP of each patient and TWA-MAP/norepinephrine (TWA-MAP/NE) dose was calculated to examine blood pressure reactivity. Among 4091 patients eligible for multivariate analysis, iCa was independently associated with ICU mortality (odds ratio, 0.17; 95% CI, 0.04-0.79; p < 0.05). Both the blood pressure parameter (TWA-MAP above 0 mm Hg [TWA-MAP-0]) and pressure reactivity parameter (TWA-MAP-0/weight-adjusted dose of norepinephrine infusion in the first 24 hr after ICU admission [TWA-MAP-0/NE]) mediated the outcome of ICU mortality with a proportion of 4.55% (95% CI, 0.16-17%; p < 0.05) and 2.6% (95% CI, 0.02-11%; p < 0.05), respectively. TWA-MAP-0 correlated positively with iCa (Spearman rank test, ρ = 0.17; p < 0.01) while no significant association was found between iCa and TWA-MAP-0/NE (Spearman rank test, ρ = -0.07; p < 0.01).

Conclusions: In this retrospective study on nonhypercalcemia patients, iCa of the first 24 hours after admission was independently associated with ICU mortality, which was potentially mediated by TWA-MAP and blood pressure reactivity (TWA-MAP/NE). iCa was also positively associated with TWA-MAP, while no general relationship was found between iCa and TWA-MAP/NE.

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低血钙和平均动脉压与ICU患者预后的关系。

研究目的我们还假设血压和血压反应性与离子化钙（iCa）有关，并可能在离子化钙与死亡率的关系中起中介作用：设计：回顾性观察研究：背景：一家综合医院的重症监护室：根据患者入院后 24 小时内的平均 iCa 值（以 1.1 mmol/L 为临界值），将非高钙血症成人患者分为两组：无干预措施：研究共纳入2013年1月至2022年12月期间北京协和医院的4947例患者，其中2160例（43.7%）患有低钙血症。总体而言，中位数（四分位数间距）年龄为 61 岁（49-71 岁），其中 2824 人（57.1%）为女性。在头 24 小时内，时间加权平均平均动脉压（TWA-MAP）分别高于 0 和 65 mm Hg，用于分析每位患者的 MAP，并计算 TWA-MAP/norepinephrine （TWA-MAP/NE）剂量，以检查血压反应性。在符合多变量分析条件的 4091 名患者中，iCa 与 ICU 死亡率独立相关（几率比为 0.17；95% CI 为 0.04-0.79；P < 0.05）。血压参数（TWA-MAP 超过 0 mm Hg [TWA-MAP-0]）和压力反应性参数（TWA-MAP-0/ICU 入院后 24 小时内输注去甲肾上腺素的重量调整剂量 [TWA-MAP-0/NE]）对 ICU 死亡率的影响分别为 4.55% (95% CI, 0.16-17%; p < 0.05) 和 2.6% (95% CI, 0.02-11%; p < 0.05)。TWA-MAP-0与iCa呈正相关（Spearman秩检验，ρ = 0.17；p < 0.01），而iCa与TWA-MAP-0/NE之间无明显关联（Spearman秩检验，ρ = -0.07；p < 0.01）：在这项针对非高钙血症患者的回顾性研究中，入院后 24 小时内的 iCa 与 ICU 死亡率密切相关，而 TWA-MAP 和血压反应性（TWA-MAP/NE）可能是这一关系的中介。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Care Medicine 医学-危重病医学

CiteScore

16.30

自引率

5.70%

发文量

728

审稿时长

2 months

期刊介绍： Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.