Total Serum Calcium and Recovery after Rehabilitation in Patients with Stroke

Mariacristina Siotto,Irene Aprile,Simona Mastropaolo,Marco Germanotta,Claudia Loreti,Massimo Santoro,Chiara Di Blasi

doi:10.3390/app10217893

Abstract

Calcium deficiency is frequently observed in stroke survivors, but no data exist concerning the relationship between calcium and rehabilitation outcome in patients with stroke. Therefore, we examined in a group of subacute stroke patients if changes in the Barthel Index after a rehabilitation treatment were associated with blood parameters related to calcium status. We retrospectively explored serum calcium status (total calcium, ionized calcium), serum total protein status, and serum albumin percentage in 30 subacute stroke patients admitted to our rehabilitation center. Patients underwent a 6-week rehabilitation treatment (each session lasting 45 min, 2 sessions/day, 6 days/week). Overall, 26.7% of patients had total calcium levels below the reference range, whereas 100% of patients had ionized calcium in the reference range. Total protein and albumin were below the reference range in about 77% and 67% of patients, respectively. We found that only total calcium was correlated with the change from baseline of the Barthel Index (BI) (rho = 0.466, p = 0.009). A multiple linear regression model confirmed that in our sample the total calcium significantly predicted the change from baseline of the Barthel Index (F5, 24 = 4.074, p = 0.008, adj. R2 = 0.346). This study suggests a possible connection between serum calcium status and total protein status of stroke patients undergoing rehabilitation treatment and rehabilitation outcomes. Further investigations are necessary to confirm the importance of testing serum calcium status of patients at admission in a rehabilitation unit for an eventual supplementation or a dietary personalized program.

Highlights

Stroke is the first cause of disability and the second largest cause of death worldwide [1].Patients after stroke have a very heterogeneous clinical spectrum together with dissimilar and often incomplete recovery of motor function in response to rehabilitation treatment [2].Malnutrition is frequently observed in stroke survivors, and a recent meta-analysis identified a plethora of potential risk factors for this condition [3]
In light of the above, in a group of subacute stroke patients admitted to our rehabilitation facility for a rehabilitation treatment of 6 weeks, we examined if changes in independence score measured by the Barthel Indexwere associated with the following blood parameters: total and ionized calcium serum levels and two other nutrition status blood parameters, in particular albumin and total protein
We retrospectively explored serum calcium status, serum total protein status, and serum albumin percentage in a group of 30 subacute stroke patients admitted to our rehabilitation center

Summary

Introduction

Patients after stroke have a very heterogeneous clinical spectrum together with dissimilar and often incomplete recovery of motor function in response to rehabilitation treatment [2]. Malnutrition is frequently observed in stroke survivors, and a recent meta-analysis identified a plethora of potential risk factors for this condition [3]. Malnutrition should be monitored in patients with stroke: it can significantly influence the outcome of post-stroke rehabilitation, leading to a poor recovery [4]. A consequence of malnutrition is calcium deficiency. Calcium is a key essential nutrient that is fundamental in the human body; it is involved in vascular contraction, vasodilatation, muscle functions, nerve transmission, intracellular signaling, and hormonal secretion [5].

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