Lower Ionized Calcium Predicts Hematoma Expansion and Poor Outcome in Patients with Hypertensive Intracerebral Hemorrhage

• Published in: World neurosurgery 2018-10, Vol.118, p.e500-e504
• Main Authors: Zhang, Yi-Bin, Zheng, Shu-Fa, Yao, Pei-Sen, Chen, Guo-Rong, Li, Guang-Hai, Li, Song-Chuan, Zheng, Yi-Fang, Wang, Jian-Qun, Kang, De-Zhi, Shang-Guan, Huang-Cheng
• Format: Article
• Language: English
• Subjects: Blood pressure; Imaging; Intracerebral hemorrhage; Stroke
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.06.223

We tested the hypothesis that ionized calcium levels at admission are associated with early hematoma expansion and functional outcome in patients with hypertensive intracerebral hemorrhage (HICH). Patients presenting with HICH were enrolled in the observational cohort study that prospectively collected age, sex, blood pressure, history of diabetes and smoking, time from symptom onset to initial computed tomography (CT), admission ionized calcium (iCa) and total calcium (tCa), coagulation function, Glasgow Coma Scale (GCS), and postoperative modified Rankin Scale score. Hematoma reconstruction on CT was performed to measure hematoma volumes. Hematoma expansion (HE) was defined as an increase of more than 30% or 6 mL in HICH volume. We performed univariate and multivariate analyses to assess for association of iCa level with early HE and functional outcome. We included 111 patients with HICH for analysis. Admission serum iCa was 1.10 mmol/L in patients with HE and 1.17 in patients without HE. Univariate analysis indicated significant difference of GCS, initial HICH volume, iCa, and tCa between the HE and non-HE groups (P < 0.05). Lower admission iCa (less than 1.12 mmol/L) was associated with HE (odds ratio [OR] 0.300, 95% confidence interval [CI] 0.095–0.951, P = 0.041) after adjustment for age, blood pressure, GCS score, time to initial CT scan, baseline HICH volume, prothrombin time, and tCa. Furthermore, predictive factors of poor outcome included iCa (OR 0.192, 95% CI 0.067–0.554, P = 0.002) and GCS score (OR 0.832, 95% CI 0.722–0.959, P = 0.011). These data support the hypothesis that lower ionized calcium is associated with early hematoma expansion and poor outcome in patients with hypertensive intracerebral hemorrhage. •Lower iCa levels were associated with a greater risk of hematoma expansion.•A lower iCa level was an independent risk factor for a poor outcome at 3 months.•Serum iCa level was inversely correlated with systolic blood pressure.•Serum tCa and iCa on admission predicted greater baseline HICH volume.•Serum iCa accurately reflects the physiologically active component in HICH.