Association of hypocalcemia with in-hospital mortality and complications in patients with acute pulmonary embolism: results from the 2017 Nationwide Inpatient Sample

Mukunthan Murthi,Farah Wani,Hafeez Shaka,Abdul Jamil,Asim Kichloo,Ramtej Atluri,Akshay Kumar,Zain El-Amir,Sujitha Velagapudi

doi:10.1186/s12890-021-01784-0

Abstract

BackgroundAcute pulmonary embolism (PE) is a common cause for hospitalization associated with significant mortality and morbidity. Disorders of calcium metabolism are a frequently encountered medical problem. The effect of hypocalcemia is not well defined on the outcomes of patients with PE. We aimed to identify the prognostic value of hypocalcemia in hospitalized PE patients utilizing the 2017 Nationwide Inpatient Sample (NIS).MethodsIn this retrospective study, we selected patients with a primary diagnosis of Acute PE using ICD 10 codes. They were further stratified based on the presence of hypocalcemia. We primarily aimed to compare in-hospital mortality for PE patients with and without hypocalcemia. We performed multivariate logistic regression analysis to adjust for potential confounders. We also used propensity‐matched cohort of patients to compare mortality.ResultsIn the 2017 NIS, 187,989 patients had a principal diagnosis of acute PE. Among the above study group, 1565 (0.8%) had an additional diagnosis of hypocalcemia. 12.4% of PE patients with hypocalcemia died in the hospital in comparison to 2.95% without hypocalcemia. On multivariate regression analysis, PE and hypocalcemia patients had 4 times higher odds (aOR-4.03, 95% CI 2.78–5.84, p < 0.001) of in-hospital mortality compared to those with only PE. We observed a similarly high odds of mortality (aOR = 4.4) on 1:1 propensity-matched analysis. The incidence of acute kidney injury (aOR = 2.62, CI 1.95–3.52, p < 0.001), acute respiratory failure (a0R = 1.84, CI 1.42–2.38, p < 0.001), sepsis (aOR = 4.99, CI 3.08–8.11, p < 0.001) and arrhythmias (aOR = 2.63, CI 1.99–3.48, p < 0.001) were also higher for PE patients with hypocalcemia.ConclusionPE patients with hypocalcemia have higher in-hospital mortality than those without hypocalcemia. The in-hospital complications were also higher, along with longer length of stay.

Highlights

Acute pulmonary embolism (PE) is a common cause for hospitalization associated with significant mortality and morbidity
We aimed to identify the prognostic value of hypocalcemia in hospitalized Pulmonary embolism (PE) patients utilizing the 2017 Nationwide Inpatient Sample
Patients with hypocalcemia had a higher number of comorbid conditions (Charlson index ≥ 3–39.9% vs. 28%) than without hypocalcemia (Table 1)

Summary

Introduction

Acute pulmonary embolism (PE) is a common cause for hospitalization associated with significant mortality and morbidity. Disorders of calcium metabolism are a frequently encountered medical problem. We aimed to identify the prognostic value of hypocalcemia in hospitalized PE patients utilizing the 2017 Nationwide Inpatient Sample (NIS). Pulmonary embolism (PE) is a common medical condition associated with significant morbidity and mortality. The exact incidence of PE is not known, approximately 900,000 persons are affected by DVT/PE per year in the United States. It is associated with significant mortality and morbidity, with sudden death being the Murthi et al BMC Pulmonary Medicine (2021) 21:410 first symptom in 25% of the patients [1]. Calcium is a part of the coagulation factor IV and is involved in the coagulation process [5]

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