A-107 Evaluating the Use of Albumin-Corrected Calcium Measurements in an Acute Care Hospital Network

IF 6.3 2区医学 Q1 MEDICAL LABORATORY TECHNOLOGY

Clinical chemistry Pub Date : 2025-10-02 DOI:10.1093/clinchem/hvaf086.105

Annie Ren, Purvi Patel, Linda Stevenson, Lisa Brown, Veronica Roberts, Nicholas Pellegrino, Saranya Arnoldo

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Abstract

Background Using albumin-corrected calcium remains a conventional practice for determining calcium homeostasis, particularly in patients with hypoalbuminemia. However, studies have demonstrated that relying on albumin-corrected calcium in patients with hypoalbuminemia can overestimate serum calcium levels. We evaluated the correlation between total calcium measurements (with or without albumin correction) and ionized calcium levels in patients with normal and low albumin levels. Our findings were valuable for providing physician education on discontinuing the report of albumin-corrected calcium in our health system. This change aims to improve patient care and optimize laboratory resources. Methods We analyzed six months of patient data for total calcium, with and without albumin correction, obtained across three hospitals (N=56465). The Payne formula [Corrected calcium (mmol/L) = total calcium (mmol/L) + 0.02 [40 - albumin (g/L)] was used to derive the albumin-corrected calcium. We assessed paired ionized calcium specimens, collected within 24 hours apart (N=3123). The linear relationship and clinical correlation were assessed between total calcium, with or without albumin correction, with ionized calcium levels. Results Linear regression showed comparably moderate correlation between uncorrected (R² = 0.75, slope= 1.58) and corrected total calcium (R² = 0.74, slope= 1.55) with ionized calcium levels. In patients with hypoalbuminemia (N=2609), the clinical concordance with ionized calcium was stronger with uncorrected calcium compared to albumin-corrected calcium (72% vs 53%). Moreover, the clinical concordance with low ionized calcium was significantly higher using uncorrected calcium, compared to corrected calcium (88% vs 20%). When the ionized calcium is normal, the concordance was similar between uncorrected and corrected calcium (62% vs 60%). Conclusion Our findings support the literature that relying on the interpretation of albumin-corrected calcium can overestimate calcium status. There is a high risk of missing true hypocalcemia, where the corrected calcium level is in the normal range while the ionized calcium level is low. The uncorrected calcium measurement was more reliable for determining calcium status and agrees better with ionized calcium, in the presence of hypoalbuminemia.

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A-107评估白蛋白校正钙测量在急症护理医院网络中的应用

背景使用白蛋白校正钙仍然是测定钙稳态的传统做法，特别是在低白蛋白血症患者中。然而，研究表明，低白蛋白血症患者依赖白蛋白校正钙可能会高估血清钙水平。我们评估了在白蛋白水平正常和低的患者中，总钙测量值（有或没有白蛋白校正）和电离钙水平之间的相关性。我们的发现对于在我们的卫生系统中停止白蛋白校正钙报告的医师教育是有价值的。这一变化旨在改善患者护理和优化实验室资源。方法：我们分析了三家医院（N=56465） 6个月的患者总钙数据，包括白蛋白校正和不校正。采用Payne公式[校正钙(mmol/L) =总钙(mmol/L) + 0.02[40 -白蛋白（g/L）]计算白蛋白校正钙。我们评估了24小时内收集的配对离子钙标本（N=3123）。评估了有或没有白蛋白校正的总钙与离子钙水平之间的线性关系和临床相关性。结果线性回归显示，未校正总钙（R²= 0.75，斜率= 1.58）与校正总钙（R²= 0.74，斜率= 1.55）与离子钙水平呈正相关。在低白蛋白血症患者（N=2609）中，与白蛋白校正钙相比，未校正钙与离子化钙的临床一致性更强（72% vs 53%）。此外，与使用矫正钙相比，未矫正钙与低电离钙的临床一致性显著更高（88% vs 20%）。当离子钙正常时，未校正和校正钙的一致性相似（62% vs 60%）。结论我们的发现支持了依赖于白蛋白校正钙的解释可能高估钙状态的文献。缺少真正的低钙血症的风险很高，即校正后的钙水平在正常范围内，而电离钙水平较低。在存在低白蛋白血症的情况下，未经校正的钙测量更可靠地确定钙状态，并且与离子钙更一致。

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来源期刊

Clinical chemistry 医学-医学实验技术

CiteScore

11.30

自引率

4.30%

发文量

212

审稿时长

1.7 months

期刊介绍： Clinical Chemistry is a peer-reviewed scientific journal that is the premier publication for the science and practice of clinical laboratory medicine. It was established in 1955 and is associated with the Association for Diagnostics & Laboratory Medicine (ADLM). The journal focuses on laboratory diagnosis and management of patients, and has expanded to include other clinical laboratory disciplines such as genomics, hematology, microbiology, and toxicology. It also publishes articles relevant to clinical specialties including cardiology, endocrinology, gastroenterology, genetics, immunology, infectious diseases, maternal-fetal medicine, neurology, nutrition, oncology, and pediatrics. In addition to original research, editorials, and reviews, Clinical Chemistry features recurring sections such as clinical case studies, perspectives, podcasts, and Q&A articles. It has the highest impact factor among journals of clinical chemistry, laboratory medicine, pathology, analytical chemistry, transfusion medicine, and clinical microbiology. The journal is indexed in databases such as MEDLINE and Web of Science.