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Background and purpose <p>The prognostic value of serum calcium in stroke remains unclear, with prior studies relying on single measurements. We aimed to identify distinct longitudinal trajectories of serum calcium during the first 7 days after admission to intensive care unit (ICU) stay and investigate their association with 30-day mortality in stroke patients.</p> Methods <p>This retrospective cohort study analyzed adult stroke patients from the MIMIC-IV database. Group-based trajectory modeling (GBTM) was applied to serial serum calcium measurements over the first 7 days to identify characteristic patterns. The primary outcome was 30-day mortality, assessed using multivariable Cox proportional hazards models adjusted for confounders selected by a combination of clinical knowledge and algorithms (LASSO and Boruta). Sensitivity analyses included propensity score matching (PSM).</p> Results <p>Among 1,274 patients, GBTM identified three distinct trajectories: traj1 (&gt; 9.5&#xa0;mg/dL; 9.5%), traj2 (8.5–9.5&#xa0;mg/dL; 58.3%), and traj3 (&lt; 8.5&#xa0;mg/dL; 32.2%). Patients in traj3 had higher illness severity scores and comorbidity burden. The 30-day mortality rate was highest in traj3 (48.5%) compared to traj2 (38.4%) and traj1 (38.0%). After multivariable adjustment, traj3 was independently associated with an increased risk of 30-day mortality compared to traj2 (hazard ratio 1.32, 95% confidence interval 1.09–1.61). Sensitivity analyses using PSM confirmed this association (HR 1.39, 1.11–1.74).​ Restricted cubic spline analysis revealed a U-shaped relationship between serum calcium levels and mortality risk.</p> Conclusions <p>Longitudinal serum calcium trajectories are significantly associated with short-term mortality in critically ill stroke patients. A persistently low trajectory (&lt; 8.5&#xa0;mg/dL) identifies those at highest risk. Monitoring dynamic calcium patterns provides prognostic information beyond a single measurement. These findings support the role of serial​ monitoring of calcium homeostasis and generate the hypothesis​ that correcting sustained hypocalcemia might improve outcomes, a premise that warrants testing in future interventional studies.</p>

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Association between serum calcium trajectories and 30-day mortality among critically ill stroke patients: a cohort study using the MIMIC-IV database

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月27日

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  • Yucheng Li,
  • Wentao Qi,
  • Suqin Shi,
  • Jingjing Sun,
  • Qingyuan Li,
  • Xiaochun Duan,
  • Demao Cao,
  • Xiaobao Gu

摘要

Background and purpose

The prognostic value of serum calcium in stroke remains unclear, with prior studies relying on single measurements. We aimed to identify distinct longitudinal trajectories of serum calcium during the first 7 days after admission to intensive care unit (ICU) stay and investigate their association with 30-day mortality in stroke patients.

Methods

This retrospective cohort study analyzed adult stroke patients from the MIMIC-IV database. Group-based trajectory modeling (GBTM) was applied to serial serum calcium measurements over the first 7 days to identify characteristic patterns. The primary outcome was 30-day mortality, assessed using multivariable Cox proportional hazards models adjusted for confounders selected by a combination of clinical knowledge and algorithms (LASSO and Boruta). Sensitivity analyses included propensity score matching (PSM).

Results

Among 1,274 patients, GBTM identified three distinct trajectories: traj1 (> 9.5 mg/dL; 9.5%), traj2 (8.5–9.5 mg/dL; 58.3%), and traj3 (< 8.5 mg/dL; 32.2%). Patients in traj3 had higher illness severity scores and comorbidity burden. The 30-day mortality rate was highest in traj3 (48.5%) compared to traj2 (38.4%) and traj1 (38.0%). After multivariable adjustment, traj3 was independently associated with an increased risk of 30-day mortality compared to traj2 (hazard ratio 1.32, 95% confidence interval 1.09–1.61). Sensitivity analyses using PSM confirmed this association (HR 1.39, 1.11–1.74).​ Restricted cubic spline analysis revealed a U-shaped relationship between serum calcium levels and mortality risk.

Conclusions

Longitudinal serum calcium trajectories are significantly associated with short-term mortality in critically ill stroke patients. A persistently low trajectory (< 8.5 mg/dL) identifies those at highest risk. Monitoring dynamic calcium patterns provides prognostic information beyond a single measurement. These findings support the role of serial​ monitoring of calcium homeostasis and generate the hypothesis​ that correcting sustained hypocalcemia might improve outcomes, a premise that warrants testing in future interventional studies.