Association between serum calcium and prognosis in patients with acute pulmonary embolism and the optimization of pulmon
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RESEARCH
Association between serum calcium and prognosis in patients with acute pulmonary embolism and the optimization of pulmonary embolism severity index Xin Wang1,3†, Yongbo Xiang3†, Ting Zhang2, Yuqing Yang4, Xuefeng Sun2* and Juhong Shi2*
Abstract Introduction: Calcium is an important coagulation factor and hypocalcemia is related to progression and poor prognosis of many cardiopulmonary diseases. However, influence of hypocalcemia on pulmonary thromboembolism (PTE) prognosis has never been reported. This study aimed to explore its prognostic value and optimize the pulmonary embolism severity index (PESI), the widely used prognosis assessment model, based on the value. Methods: PTE patients’ variables in PESI and other related clinical characteristics including admission serum calcium were collected. Associations between these variables and PTE mortality were assessed by logistic regression and cox analysis. Variables significantly associated with 30-day PTE mortality were included to develop a new prognosis prediction rule and then its validity was compared with PESI and simplified PESI (sPESI). Results: 496 PTE patients were included and 49.48% patients had hypocalcemia (serum calcium ≤ 2.13 mmol/L) in admission, showing higher 7-day (P = 0.021), 14-day (P = 0.002), 30-day (13.03% vs 4.98%, P = 0.002) mortalities than patients without hypocalcemia. Adjusting for variables in PESI, hypocalcemia was further revealed to be an independent predictor of 30-day mortality (P = 0.014). The optimal prediction rule contained hypocalcemia and 5 variables in PESI and sPESI, showing higher predictive validity [sensitivity (Sen): 0.930, specificity (Spec): 0.390, area under curve (AUC): 0.800] than PESI (Sen: 0.814, Spec: 0.367, AUC: 0.716) and sPESI (Sen: 0.907, Spec: 0.216, AUC: 0.703). Conclusions: Hypocalcemia is an independent predictor of the mortality following acute PTE. Based on hypocalcemia, the optimal prediction rule showed higher validity than PESI and sPESI. Keywords: Pulmonary thromboembolism, Serum calcium, Hypocalcemia, Prognosis, Pulmonary embolism severity index
*Correspondence: [email protected]; [email protected] † Xin Wang and Yongbo Xiang have contributed equally to this study 2 Department of Respiration, Peking Union Medical College Hospital, No. 1, Shuaifuyuan, Dongcheng District, Beijing 100730, China Full list of author information is available at the end of the article
Introduction Acute pulmonary thromboembolism (PTE) is a lifethreatening disease with high morbidity and mortality, which may cause an annual incidence rates ranging from 39 to 115 per 100,000 population and a 14-day mortality of 11.4% [1, 2]. Prognostic assessment of PTE patients, especially the evaluation of early death risk shows great significance for treatment.
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