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BACKGROUND: The serum calcium plays a role as a cofactor in critical steps such as cardiac contractility, vascular tone, and the coagulation cascade. This study aimed to determine if the level of ionized calcium (I.Ca) can predict outcomes in patients with spontaneous subarachnoid hemorrhage (SAH) in the emergency department. METHODS: The study was a retrospective cross-sectional case series. Patients aged 18 and over diagnosed with spontaneous SAH in the emergency department were included in the study. Patients' demographic characteristics, comorbidities, vital signs, laboratory parameters, World Federation of Neurosurgical Societies score, SAH grading according to the Fisher scale, needs of mechanical ventilation and inotropic treatment, administered treatments, complications, Rankin scores at discharge, and outcome were recorded in a standard data form. RESULTS: A total of 267 patients were studied, with a mean age of 55.5±13.4 years, and 53.9% (n=144) were female. Hydrocephalus was present in 16.5% of patients. The average hospital stay was 20.4±19.8 days. Mortality rate was 34.8% (n=93). Mortality was significantly higher in patients with low calcium levels upon admission (I.Ca1) (p=0.024). Ionized calcium levels (I.Ca2) during complication development independently predicted mortality (OR: 0.945, 95% CI: 0.898-0.996, p=0.034). Patients with poor neurological outcomes (Rankin: 3-6) had significantly lower initial ionized calcium levels (p=0.002). CONCLUSION: The ionized calcium level is a readily accessible blood gas parameter that assists clinicians in predicting functional independence and mortality at discharge in patients presenting to the emergency department with spontaneous subarachnoid hemorrhage.
RESUMO
AIM: The aim of the study is to investigate the relationship between negative acute-phase reactants and positive acute-phase reactants with in-hospital mortality in patients diagnosed with acute ischemic stroke (AIS) in the emergency department (ED). METHODS AND MATERIALS: Patients aged 18 and older who presented to the ED of a tertiary hospital with AIS were included in the study. Demographic and clinical characteristics, laboratory parameters, acute-phase reactants, National Institutes of Health Stroke Scale (NIHSS), and outcome data of the included patients were recorded on a standard data form. RESULTS: A total of 588 patients were included in the study. When the in-hospital mortality of patients was examined, the mortality rate was 17.7%. In the analysis for predicting mortality, it was determined that albumin had the highest predictive power between the area under the curve (AUC) and the determined predictive values (AUC: 0.759, 95% CI 0.707-0.810, p < 0.001). The analyses of the study data revealed that albumin (<0.001) and TF (p = 0.049), which are negative acute-phase reactants, were independent predictors of mortality. According to our study data, in patients with AIS, for each unit decrease in albumin level at the time of ED admission, the risk of mortality increased by 0.868 times, and for each unit decrease in TF level, the risk of mortality increased by 0.593 times. CONCLUSION: According to the study data, albumin and TF levels, which are negative acute-phase reactants, are independent determinants of in-hospital mortality in patients with acute ischemic stroke in the emergency department.