Association between admission serum calcium and clinical outcomes in patients with large ischemic stroke after endovascular treatment

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Large ischemic stroke due to anterior circulation large vessel occlusion undergoing endovascular treatment (n=359). Intervention: Higher admission total serum calcium levels (Tertile 2: 2.16–2.28 mmol/L; Tertile 3: >2.28 mmol/L) vs. Lowest admission total serum calcium tertile (Tertile 1: ≤2.15 mmol/L). Primary outcome: Favorable functional outcome (modified Rankin Scale score 0–3) at 90 days (Tertile 2 vs Tertile 1) (OR 3.14, 95% CI 1.59-6.17, p=0.001).

Q: What does this research mean for the field?

Higher admission total serum calcium levels in patients with large ischemic stroke treated with endovascular therapy are associated with improved 90-day functional outcomes and decreased mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Shaowei Jing; Qin Zhang; Linyu Li; Sheng Zhou; Lilan Wang; Haoxuan Zhu; Gaoming Li; Chunye Chen; Mingyang Chen; Yuhan Fan; Qiuyi Yang; Yihui Yang; Yian Chen; Binghan Wang; Guanting Heng; Chawen Ding; Jiaxing Song; Zhenhua Zhou; Xuexiao ZHAO

doi:10.1186/s12883-026-05575-0

Key result

Higher admission calcium linked to ~3.1-fold higher odds of favorable 90-day outcome after EVT.

OR 3.14
95% CI 1.59-6.17
P=0.001
n=359

Why the study?

The association between admission total serum calcium levels and clinical outcomes in patients with large ischemic stroke following endovascular treatment needed to be examined.

Does a higher admission total serum calcium level improve 90-day functional outcomes (mRS 0–3) and reduce mortality in patients with large ischemic stroke undergoing endovascular treatment?

Key Points

To examine the association between admission total serum calcium levels and clinical outcomes at 90 days in patients with large ischemic stroke undergoing endovascular treatment.
Subgroup analysis of a prospective cohort of 359 patients with large ischemic stroke who underwent endovascular treatment and had admission total serum calcium measured.
Patients were categorized into tertiles based on admission total serum calcium: Tertile 1 (≤ 2.15 mmol/L, n=123), Tertile 2 (2.16–2.28 mmol/L, n=119), and Tertile 3 (> 2.28 mmol/L, n=117).
Achieving mRS 0–3 at 90 days occurred in 23.6% (29/123) of Tertile 1, 48.7% (58/119) of Tertile 2 (aOR 3.14, 95% CI 1.59–6.17, P = 0.001), and 45.3% (53/117) of Tertile 3 (aOR 2.57, 95% CI 1.31–5.03, P = 0.006).
Ninety-day mortality was 52.8% (65/123) in Tertile 1, 28.6% (34/119) in Tertile 2 (aOR 0.30, 95% CI 0.15–0.58, P < 0.001), and 29.9% (35/117) in Tertile 3 (aOR 0.37, 95% CI 0.19–0.71, P = 0.003).
Symptomatic intracranial hemorrhage within 48 h occurred in 11.4% (14/123) of Tertile 1, 7.6% (9/119) of Tertile 2 (aOR 0.70, 95% CI 0.28–1.79, P = 0.459), and 14.5% (17/117) of Tertile 3 (aOR 1.51, 95% CI 0.67–3.42, P = 0.324), showing no significant differences.

Study Design

Type

Cohort (n=359)

Multicenter

Yes

Structured PICO

Does a higher admission total serum calcium level improve 90-day functional outcomes (mRS 0–3) and reduce mortality in patients with large ischemic stroke undergoing endovascular treatment?

P

Population

359 adults (median age 68 years, 39.0% female) across 38 stroke centers in China with large anterior circulation ischemic stroke (ASPECTS 0–5) treated with endovascular thrombectomy within 24 hours of onset, followed for 90 days.

E

Exposure

Higher admission total serum calcium levels following endovascular treatment (EVT): Tertile 2 (2.16–2.28 mmol/L, n=119) and Tertile 3 (>2.28 mmol/L, n=117).

C

Comparator

Lowest tertile of admission total serum calcium levels: Tertile 1 (≤2.15 mmol/L, n=123) following endovascular treatment (EVT).

O

Outcome

Favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0–3 at 90 days, assessed through outpatient visits or telephone interviews.hard clinical

Main Result

Odds Ratio: 3.14 (95% CI 1.59–6.17)

Absolute Event Rate: 48.7% vs 23.6%

p-value: p=0.001

In patients with large ischemic stroke undergoing endovascular treatment, higher admission total serum calcium levels (>2.15 mmol/L) are independently associated with nearly triple the odds of favorable 90-day functional outcomes and significantly lower mortality, without affecting symptomatic intracranial hemorrhage rates.

Limitations

Observational cohort design precludes causal inference and requires validation in RCTs
Serum calcium levels were measured only once at admission, precluding assessment of temporal fluctuations
Subgroup analyses were exploratory with relatively small sample sizes in several strata, limiting statistical power
Unmeasured potential confounders such as serum albumin, renal function, nutritional status, inflammatory status, and frailty were not captured in the registry
Ionized calcium was not assessed; only total serum calcium was measured.
Exact blood sampling times relative to symptom onset and EVT were not uniformly recorded.
Modest E-values for the confidence limits indicated that residual unmeasured confounding could not be excluded.
Restricted cubic spline analysis for nonlinear association with mortality should be considered exploratory and hypothesis-generating.

Implication

Higher admission calcium may predict better EVT outcomes in large stroke; hypothesis-generating and should not change practice.

Abstract

This study aimed to examine the association between admission total serum calcium (Ca) levels and clinical outcomes in patients with large ischemic stroke following endovascular treatment (EVT). This study is a subgroup analysis of a prospective cohort, including 359 patients who underwent EVT and had total serum calcium levels measured at admission. Patients were stratified into three groups based on their admission total serum calcium levels, categorized according to tertiles. The primary outcome was modified Rankin Scale (mRS) score 0–3 at 90 days. Safety outcomes included 90-day mortality and symptomatic intracranial hemorrhage (sICH) within 48 h. The 359 included patients were stratified according to tertiles of admission total serum calcium levels: Tertile 1 ( ≤ 2.15 mmol/L), Tertile 2 (2.16–2.28 mmol/L), and Tertile 3 ( > 2.28 mmol/L). Compared with patients in Tertile 1, those in Tertile 2 had significantly higher odds of achieving mRS 0–3 (adjusted odds ratio [aOR] 3.14, 95% CI 1.59–6.17, P = 0.001), and patients in Tertile 3 also demonstrated significantly increased odds of mRS 0–3 (aOR 2.57, 95% CI 1.31–5.03, P = 0.006). In addition, both higher tertiles were associated with significantly lower mortality compared with Tertile 1. There were no significant differences in the incidence of sICH among the three groups. In patients with large ischemic stroke undergoing EVT, an elevated admission serum calcium level was associated with a higher likelihood of mRS 0–3 and lower mortality. These findings suggest that blood calcium levels may serve as a potential prognostic biomarker for this population.

Discussion

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Cite This Study

Jing et al. (2026) conducted a cohort in Large ischemic stroke due to anterior circulation large vessel occlusion undergoing endovascular treatment (n=359). Higher admission total serum calcium levels (Tertile 2: 2.16–2.28 mmol/L; Tertile 3: >2.28 mmol/L) vs. Lowest admission total serum calcium tertile (Tertile 1: ≤2.15 mmol/L) was evaluated on Favorable functional outcome (modified Rankin Scale score 0–3) at 90 days (Tertile 2 vs Tertile 1) (OR 3.14, 95% CI 1.59-6.17, p=0.001). Higher admission serum calcium levels (Tertile 2 and Tertile 3 vs Tertile 1) were significantly associated with increased odds of 90-day mRS 0–3 (aOR 3.14, P=0.001 and aOR 2.57, P=0.006) after EVT.

synapsesocial.com/papers/6ae682cae432e7a5c4ef3780 https://doi.org/10.1186/s12883-026-05575-0

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Association between admission serum calcium and clinical outcomes in patients with large ischemic stroke after endovascular treatment

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association between admission serum calcium and clinical outcomes in patients with large ischemic stroke after endovascular treatment

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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