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Abstract & Commentary
Do Serum Ionized Calcium Levels Matter in the ICU?
By Andrew M. Luks, MD , Pulmonary and Critical Care Medicine, University of Washington, Seattle, is Associate Editor for Critical Care Alert .
Dr. Luks reports no financial relationship to this field of study.
Synopsis: This retrospective study of more than 7000 patients from four combined medical-surgical ICUs demonstrated that ionized calcium levels are unrelated to mortality over a broad range of values but are independent predictors of mortality when levels are severely increased or decreased.
Source: Egi M, et al. Ionized calcium concentration and outcome in critical illness. Crit Care Med 2011;39:314-321.
Although previous studies have suggested that hypocalcemia, a common problem in critical illness, is associated with increased mortality in ICU patients, and correction of hypocalcemia has been advocated to prevent neurologic and cardiovascular complications, the literature is still unclear as to the precise relationship between abnormal calcium levels -- both hypo- and hypercalcemia -- and ICU outcomes.
Egi and colleagues addressed this question using a retrospective study of a large number of patients in multiple medical/surgical ICUs. They gathered data from 7024 patients who were part of an established quality-assurance project across four hospitals in Australia, 43% of whom were surgical patients. They included all patients admitted over a 4-year period, excluding those who required renal replacement therapy using citrate-based anticoagulation and those for whom arterial blood gas data were not available. All ionized calcium (iCa) concentrations were...