Skip to main content
Top
Published in: BMC Neurology 1/2022

Open Access 01-12-2022 | Stroke | Research

Higher serum albumin-corrected calcium levels are associated with revascularization and poor outcome after mechanical thrombectomy

Authors: Xinwei He, Baomei Lin, Taotao Tao, Qiuyue Chen, Jinhua Wang, Jiaolei Jin

Published in: BMC Neurology | Issue 1/2022

Login to get access

Abstract

Background

Serum calcium abnormalities have been determined to be associated with the risk and outcome of stroke. The aim of the present study was to examine the associations of serum calcium with vascular recanalization, symptomatic intracranial haemorrhage and functional outcome in stroke patients after mechanical thrombectomy.

Methods

A total of 192 patients treated with mechanical thrombectomy for anterior circulation large vessel occlusion were consecutively included from August 2017 to June 2021. Serum calcium levels were measured on admission, and albumin-corrected calcium levels were calculated for subsequent analysis. Successful arterial revascularization was defined as a modified Thrombolysis in Cerebral Infarction scale score ≥ 2b. Symptomatic intracranial haemorrhage was assessed according to the European Cooperative Acute Stroke Study (ECASS) III criteria. Poor functional outcome was defined as a modified Rankin Scale score > 2 at 3 months.

Results

Patients with poor outcomes had higher albumin-corrected calcium levels than patients with good outcomes before (2.20 (2.10, 2.30) mmol/L vs. 2.13 (2.04, 2.24) mmol/L, P = 0.002), and after adjusting for other factors (AOR 95% CI, 1.812 (1.253, 2.621), P = 0.002). Patients with unsuccessful recanalization had higher albumin-corrected calcium levels than those with recanalization (2.26 (2.09, 2.46) mmol/L vs. 2.17 (2.07, 2.27) mmol/L, P = 0.029), and after adjusting for other factors (AOR 95% CI, 2.068 (1.214, 3.524)), P = 0.008). No association was found between albumin-corrected calcium and symptomatic intracranial haemorrhage.

Conclusions

Higher serum albumin-corrected calcium levels are independently associated with revascularization and poor outcome in stroke patients after mechanical thrombectomy.
Appendix
Available only for authorised users
Literature
1.
go back to reference Diseases GBD, Injuries C. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2020;396(10258):1204–22.CrossRef Diseases GBD, Injuries C. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2020;396(10258):1204–22.CrossRef
2.
go back to reference Chen Y, Wright N, Guo Y, Turnbull I, Kartsonaki C, Yang L, et al. Mortality and recurrent vascular events after first incident stroke: a 9-year community-based study of 0.5 million Chinese adults. Lancet Glob Health. 2020;8(4):e580–90.CrossRef Chen Y, Wright N, Guo Y, Turnbull I, Kartsonaki C, Yang L, et al. Mortality and recurrent vascular events after first incident stroke: a 9-year community-based study of 0.5 million Chinese adults. Lancet Glob Health. 2020;8(4):e580–90.CrossRef
3.
go back to reference Sarraj A, Mlynash M, Savitz SI, Heit JJ, Lansberg MG, Marks MP, et al. Outcomes of Thrombectomy in transferred patients with ischemic stroke in the late window: a subanalysis from the DEFUSE 3 trial. JAMA Neurol. 2019;76(6):682–9.CrossRef Sarraj A, Mlynash M, Savitz SI, Heit JJ, Lansberg MG, Marks MP, et al. Outcomes of Thrombectomy in transferred patients with ischemic stroke in the late window: a subanalysis from the DEFUSE 3 trial. JAMA Neurol. 2019;76(6):682–9.CrossRef
4.
go back to reference Kutikhin AG, Feenstra L, Kostyunin AE, Yuzhalin AE, Hillebrands JL, Krenning G. Calciprotein particles: balancing mineral homeostasis and vascular pathology. Arterioscler Thromb Vasc Biol. 2021;41(5):1607–24.CrossRef Kutikhin AG, Feenstra L, Kostyunin AE, Yuzhalin AE, Hillebrands JL, Krenning G. Calciprotein particles: balancing mineral homeostasis and vascular pathology. Arterioscler Thromb Vasc Biol. 2021;41(5):1607–24.CrossRef
5.
go back to reference Tintut Y, Demer LL. Potential impact of the steroid hormone, vitamin D, on the vasculature. Am Heart J. 2021;239:147–53.CrossRef Tintut Y, Demer LL. Potential impact of the steroid hormone, vitamin D, on the vasculature. Am Heart J. 2021;239:147–53.CrossRef
6.
go back to reference Rohrmann S, Garmo H, Malmstrom H, Hammar N, Jungner I, Walldius G, et al. Association between serum calcium concentration and risk of incident and fatal cardiovascular disease in the prospective AMORIS study. Atherosclerosis. 2016;251:85–93.CrossRef Rohrmann S, Garmo H, Malmstrom H, Hammar N, Jungner I, Walldius G, et al. Association between serum calcium concentration and risk of incident and fatal cardiovascular disease in the prospective AMORIS study. Atherosclerosis. 2016;251:85–93.CrossRef
7.
go back to reference Dibaba DT, Xun P, Fly AD, Bidulescu A, Tsinovoi CL, Judd SE, et al. Calcium intake and serum calcium level in relation to the risk of ischemic stroke: findings from the REGARDS study. J Stroke. 2019;21(3):312–23.CrossRef Dibaba DT, Xun P, Fly AD, Bidulescu A, Tsinovoi CL, Judd SE, et al. Calcium intake and serum calcium level in relation to the risk of ischemic stroke: findings from the REGARDS study. J Stroke. 2019;21(3):312–23.CrossRef
8.
go back to reference Morotti A, Charidimou A, Phuah CL, Jessel MJ, Schwab K, Ayres AM, et al. Association between serum calcium level and extent of bleeding in patients with intracerebral hemorrhage. JAMA Neurol. 2016;73(11):1285–90.CrossRef Morotti A, Charidimou A, Phuah CL, Jessel MJ, Schwab K, Ayres AM, et al. Association between serum calcium level and extent of bleeding in patients with intracerebral hemorrhage. JAMA Neurol. 2016;73(11):1285–90.CrossRef
9.
go back to reference You S, Han Q, Xu J, Zhong C, Zhang Y, Liu H, et al. Serum calcium and phosphate levels and short- and long-term outcomes in acute intracerebral hemorrhage patients. J Stroke Cerebrovasc Dis. 2016;25(4):914–20.CrossRef You S, Han Q, Xu J, Zhong C, Zhang Y, Liu H, et al. Serum calcium and phosphate levels and short- and long-term outcomes in acute intracerebral hemorrhage patients. J Stroke Cerebrovasc Dis. 2016;25(4):914–20.CrossRef
10.
go back to reference Can A, Rudy RF, Castro VM, Dligach D, Finan S, Yu S, et al. Low serum calcium and magnesium levels and rupture of intracranial aneurysms. Stroke. 2018;49(7):1747–50.CrossRef Can A, Rudy RF, Castro VM, Dligach D, Finan S, Yu S, et al. Low serum calcium and magnesium levels and rupture of intracranial aneurysms. Stroke. 2018;49(7):1747–50.CrossRef
11.
go back to reference Zhang JF, Meng X, Jing J, Pan Y, Wang YL, Zhao XQ, et al. Serum calcium and long-term outcome after ischemic stroke: results from the China national stroke registry III. Atherosclerosis. 2021;325:24–9.CrossRef Zhang JF, Meng X, Jing J, Pan Y, Wang YL, Zhao XQ, et al. Serum calcium and long-term outcome after ischemic stroke: results from the China national stroke registry III. Atherosclerosis. 2021;325:24–9.CrossRef
12.
go back to reference Chung JW, Ryu WS, Kim BJ, Yoon BW. Elevated calcium after acute ischemic stroke: association with a poor short-term outcome and long-term mortality. J Stroke. 2015;17(1):54–9.CrossRef Chung JW, Ryu WS, Kim BJ, Yoon BW. Elevated calcium after acute ischemic stroke: association with a poor short-term outcome and long-term mortality. J Stroke. 2015;17(1):54–9.CrossRef
13.
go back to reference Ovbiagele B, Starkman S, Teal P, Lyden P, Kaste M, Davis SM, et al. Serum calcium as prognosticator in ischemic stroke. Stroke. 2008;39(8):2231–6.CrossRef Ovbiagele B, Starkman S, Teal P, Lyden P, Kaste M, Davis SM, et al. Serum calcium as prognosticator in ischemic stroke. Stroke. 2008;39(8):2231–6.CrossRef
14.
go back to reference Adams HP Jr, Davis PH, Leira EC, Chang KC, Bendixen BH, Clarke WR, et al. Baseline NIH stroke scale score strongly predicts outcome after stroke: a report of the trial of org 10172 in acute stroke treatment (TOAST). Neurology. 1999;53(1):126–31.CrossRef Adams HP Jr, Davis PH, Leira EC, Chang KC, Bendixen BH, Clarke WR, et al. Baseline NIH stroke scale score strongly predicts outcome after stroke: a report of the trial of org 10172 in acute stroke treatment (TOAST). Neurology. 1999;53(1):126–31.CrossRef
15.
go back to reference Mohammaden MH, Haussen DC, Pisani L, Al-Bayati AR, Perry da Camara C, Bhatt N, et al. Baseline ASPECTS and hypoperfusion intensity ratio influence the impact of first pass reperfusion on functional outcomes. J Neurointerv Surg. 2021;13(2):124–9.CrossRef Mohammaden MH, Haussen DC, Pisani L, Al-Bayati AR, Perry da Camara C, Bhatt N, et al. Baseline ASPECTS and hypoperfusion intensity ratio influence the impact of first pass reperfusion on functional outcomes. J Neurointerv Surg. 2021;13(2):124–9.CrossRef
16.
go back to reference Smith JD, Wilson S, Schneider HG. Misclassification of calcium status based on albumin-adjusted calcium: studies in a tertiary hospital setting. Clin Chem. 2018;64(12):1713–22.CrossRef Smith JD, Wilson S, Schneider HG. Misclassification of calcium status based on albumin-adjusted calcium: studies in a tertiary hospital setting. Clin Chem. 2018;64(12):1713–22.CrossRef
17.
go back to reference Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. 3rd: classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in acute stroke treatment. Stroke. 1993;24(1):35–41.CrossRef Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. 3rd: classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in acute stroke treatment. Stroke. 1993;24(1):35–41.CrossRef
18.
go back to reference Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317–29.CrossRef Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317–29.CrossRef
19.
go back to reference Aly M, Abdalla RN, Batra A, Shaibani A, Hurley MC, Jahromi BS, et al. Follow-up neutrophil-lymphocyte ratio after stroke thrombectomy is an independent biomarker of clinical outcome. J Neurointerv Surg. 2021;13(7):609–13.CrossRef Aly M, Abdalla RN, Batra A, Shaibani A, Hurley MC, Jahromi BS, et al. Follow-up neutrophil-lymphocyte ratio after stroke thrombectomy is an independent biomarker of clinical outcome. J Neurointerv Surg. 2021;13(7):609–13.CrossRef
20.
go back to reference Shin S, Kim KJ, Chang HJ, Cho I, Kim YJ, Choi BW, et al. Impact of serum calcium and phosphate on coronary atherosclerosis detected by cardiac computed tomography. Eur Heart J. 2012;33(22):2873–81.CrossRef Shin S, Kim KJ, Chang HJ, Cho I, Kim YJ, Choi BW, et al. Impact of serum calcium and phosphate on coronary atherosclerosis detected by cardiac computed tomography. Eur Heart J. 2012;33(22):2873–81.CrossRef
21.
go back to reference Zhu H, Wang H, Jia Y, Cheng L, Cheng X. Increased serum calcium levels are associated with carotid atherosclerotic plaque in normocalcaemic individuals with type 2 diabetes. Ther Adv Endocrinol Metab. 2021;12:2042018821995369.PubMedPubMedCentral Zhu H, Wang H, Jia Y, Cheng L, Cheng X. Increased serum calcium levels are associated with carotid atherosclerotic plaque in normocalcaemic individuals with type 2 diabetes. Ther Adv Endocrinol Metab. 2021;12:2042018821995369.PubMedPubMedCentral
22.
go back to reference Guo Y, Yan S, Zhang S, Zhang X, Chen Q, Liu K, et al. Lower serum calcium level is associated with hemorrhagic transformation after thrombolysis. Stroke. 2015;46(5):1359–61.CrossRef Guo Y, Yan S, Zhang S, Zhang X, Chen Q, Liu K, et al. Lower serum calcium level is associated with hemorrhagic transformation after thrombolysis. Stroke. 2015;46(5):1359–61.CrossRef
23.
go back to reference Appel SA, Molshatzki N, Schwammenthal Y, Merzeliak O, Toashi M, Sela BA, et al. Serum calcium levels and long-term mortality in patients with acute stroke. Cerebrovasc Dis. 2011;31(1):93–9.CrossRef Appel SA, Molshatzki N, Schwammenthal Y, Merzeliak O, Toashi M, Sela BA, et al. Serum calcium levels and long-term mortality in patients with acute stroke. Cerebrovasc Dis. 2011;31(1):93–9.CrossRef
24.
go back to reference Tan G, Yuan R, Wei C, Xu M, Liu M. Serum magnesium but not calcium was associated with hemorrhagic transformation in stroke overall and stroke subtypes: a case-control study in China. Neurol Sci. 2018;39(8):1437–43.CrossRef Tan G, Yuan R, Wei C, Xu M, Liu M. Serum magnesium but not calcium was associated with hemorrhagic transformation in stroke overall and stroke subtypes: a case-control study in China. Neurol Sci. 2018;39(8):1437–43.CrossRef
25.
go back to reference Wang C, Jia Q, Sun C, Jing C. Calcium sensing receptor contribute to early brain injury through the CaMKII/NLRP3 pathway after subarachnoid hemorrhage in mice. Biochem Biophys Res Commun. 2020;530(4):651–7.CrossRef Wang C, Jia Q, Sun C, Jing C. Calcium sensing receptor contribute to early brain injury through the CaMKII/NLRP3 pathway after subarachnoid hemorrhage in mice. Biochem Biophys Res Commun. 2020;530(4):651–7.CrossRef
26.
go back to reference Novorolsky RJ, Nichols M, Kim JS, Pavlov EV. J JW, Wilson JJ, Robertson GS: the cell-permeable mitochondrial calcium uniporter inhibitor Ru265 preserves cortical neuron respiration after lethal oxygen glucose deprivation and reduces hypoxic/ischemic brain injury. J Cerebral Blood Flow Metab. 2020;40(6):1172–81.CrossRef Novorolsky RJ, Nichols M, Kim JS, Pavlov EV. J JW, Wilson JJ, Robertson GS: the cell-permeable mitochondrial calcium uniporter inhibitor Ru265 preserves cortical neuron respiration after lethal oxygen glucose deprivation and reduces hypoxic/ischemic brain injury. J Cerebral Blood Flow Metab. 2020;40(6):1172–81.CrossRef
Metadata
Title
Higher serum albumin-corrected calcium levels are associated with revascularization and poor outcome after mechanical thrombectomy
Authors
Xinwei He
Baomei Lin
Taotao Tao
Qiuyue Chen
Jinhua Wang
Jiaolei Jin
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2022
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-022-02856-2

Other articles of this Issue 1/2022

BMC Neurology 1/2022 Go to the issue