Effect of baseline hypocalcaemia on volume of intracerebral haemorrhage in patients presenting within 72 hours from symptom onset.

Affiliation

Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. Electronic address: [Email]

Abstract

BACKGROUND : Calcium has a pivotal role in haemostasis. We investigated the association of baseline calcium levels with admission intracerebral haemorrhage (ICH) volume.
METHODS : This is a retrospective analysis of consecutive ICH patients in an academic hospital between January 2005 and March 2010. Computed tomography (CT) of the brain and serum/plasma ionized calcium had to be taken within 72 h of symptom onset and within 12 h of each other in order to fulfil the study criteria. ICH cases related to trauma or tumour as well as sole intraventricular haemorrhages were excluded. Baseline haematoma volumes were calculated using semiautomated planimetry. The hypocalcaemic (Ca-ion <1.16 mmol/L) and normocalcaemic (1.16-1.30 mmol/L) patient groups were compared in univariate analyses. Association between admission hypocalcaemia and haematoma volume was studied using multivariable regression models.
RESULTS : Out of 1013 consecutive patients, 447 fulfilled the study criteria. Hypocalcaemic patients (n = 178; 39.8%) had larger baseline hematoma volumes (median 30.2 mL, IQR 11.4-58.7 mL), compared to normocalcaemic patients (n = 255; 57.0%; median 16.8 mL, IQR 7.4-44.2 mL). The median ICH volume among hypercalcaemic patients (n = 14; 3.1% of included patients) was 6.5 mL (IQR 3.1-34.6 mL). On linear regression, admission hypocalcaemia was independently associated with larger hematoma volumes (β = 11.77; 95% CI 4.66-18.87, P = 0.01). Patients with larger haematoma volumes had higher mortality.
CONCLUSIONS : Hypocalcaemia is associated with larger admission haematoma volumes among ICH patients. Higher mortality among hypocalcaemic patients is very likely mediated through larger ICH volumes.

Keywords

Haematoma volume,Intracerebral haemorrhage,Serum calcium,Stroke outcome,

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