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Background <p>Calcium is critically involved in bone metabolism and stability, nerve excitability and intercellular signal transduction.</p> Methods <p>In this retrospective study, calcium plasma concentrations of all patients treated in 2018 at our institution were evaluated. As approximately 50% of the plasma calcium is bound to plasma proteins, in particular albumin, additionally the respective plasma albumin concentration was determined and the albumin-corrected calcium plasma concentration was estimated.</p> Results <p>In 1246 of 1721 cases the plasma calcium concentration on admission was normal (2.15–2.55 mmol/l), in 421 cases hypocalcemia (&lt; 2.15 mmol/l) and in 38&#xa0;cases hypercalcemia (&gt; 2.55 mmol/l) were detected. In 1226 of 1543 cases (79.5%) hypoalbuminemia was noted. After correction of the plasma calcium levels for plasma albumin by the modified Payne equation, the corrected plasma calcium was normal in 1272 cases (73.9%), decreased in 15&#xa0;cases (0.9%), and elevated in 256 cases (14.9%). The frequency of hypercalcemia &gt; 2.8 mmol/l requiring rapid clinical interventions without correction for plasma albumin was 6&#xa0;of 1705 patients (0.4%), after correction for albumin 24&#xa0;of 1543 patients (1.6%). In logistic regression analysis, higher albumin was strongly associated with a&#xa0;decreased mortality (odds ratio, OR = 0.88, 95% confidence interval, CI 0.83–0.94, <i>p</i> &lt; 0.001), whereas the plasma calcium concentration had no independent influence on mortality.</p> Conclusion <p>Without correction for plasma albumin, approximately 25% of the patients were hypocalcemic on admission. After correction for plasma albumin, this rate fell to &lt; 1%. We suggest that the determination of plasma albumin should be included in the clinical routine on admission in all geriatric patients.</p>

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Adjustment of total plasma calcium for albumin concentrations avoids overdiagnosis of hypocalcemia in geriatric patients

  • 期刊论文

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  • 发表日期：

    2026年1月28日

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  • Evelyn John,
  • Heide Siggelkow,
  • Johannes Wieditz,
  • Olga Kunz,
  • Marija Djukic,
  • Roland Nau

摘要

Background

Calcium is critically involved in bone metabolism and stability, nerve excitability and intercellular signal transduction.

Methods

In this retrospective study, calcium plasma concentrations of all patients treated in 2018 at our institution were evaluated. As approximately 50% of the plasma calcium is bound to plasma proteins, in particular albumin, additionally the respective plasma albumin concentration was determined and the albumin-corrected calcium plasma concentration was estimated.

Results

In 1246 of 1721 cases the plasma calcium concentration on admission was normal (2.15–2.55 mmol/l), in 421 cases hypocalcemia (< 2.15 mmol/l) and in 38 cases hypercalcemia (> 2.55 mmol/l) were detected. In 1226 of 1543 cases (79.5%) hypoalbuminemia was noted. After correction of the plasma calcium levels for plasma albumin by the modified Payne equation, the corrected plasma calcium was normal in 1272 cases (73.9%), decreased in 15 cases (0.9%), and elevated in 256 cases (14.9%). The frequency of hypercalcemia > 2.8 mmol/l requiring rapid clinical interventions without correction for plasma albumin was 6 of 1705 patients (0.4%), after correction for albumin 24 of 1543 patients (1.6%). In logistic regression analysis, higher albumin was strongly associated with a decreased mortality (odds ratio, OR = 0.88, 95% confidence interval, CI 0.83–0.94, p < 0.001), whereas the plasma calcium concentration had no independent influence on mortality.

Conclusion

Without correction for plasma albumin, approximately 25% of the patients were hypocalcemic on admission. After correction for plasma albumin, this rate fell to < 1%. We suggest that the determination of plasma albumin should be included in the clinical routine on admission in all geriatric patients.