International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2015): 78.96 | Impact Factor (2015): 6.391 Volume 6 Issue 4, April 2017 www.ijsr.net Licensed Under Creative Commons Attribution CC BY Low Adjusted Serum Calcium Level as a Predictor of Poor Outcome in Patient With Acute Ischemic Stroke Agus Suryawan 1 , AABN Nuartha 2 , Thomas Eko Purwata 3 , DPG Purwa Samatra 4 , I Putu Eka Widyadharma 5 Neurology Department of Udayana University / Sanglah General Hospital, Denpasar Abstract: Calcium plays an important role in the pathogenesis of ischemic cell damage. Intracellular calcium accumulation leads to neuronal damage by triggering the cycle of cytotoxic events, however the relationship of Adjusted serum calcium levels and the pathways involved in ischemic injury is unclear. The aim of this study is to determine whether low Adjusted serum calcium levels can be used as predictor of poor outcome in acute ischemic stroke patient . This is a prospective cohort study of acute ischemic stroke patients admitted to Sanglah General Hospital from December 2016 until February 2017. Adjusted serum calcium level was obtained ≤72 hours from onset. Outcome was classified as poor and good, according to the National Institutes of Health Stroke Scale (NIHSS) score taken on admission and 7 days after the onset. Statistical analysis was performed using using Chi-Square. A total of 60 patients were enrolled and met the criteria. Subject’s characteristic described by sex, age, onset, stroke type, serum adjusted calcium level, first and second NIHSS score. Serum adjusted calcium level mean was lower in poor outcome group (8,78 ± 0,07) than subjects in the good outcome (9,05 ± 0,06). Chi-square analysis revealed lower Adjusted serum calcium levels accompanied by poor outcomes statistically significant (RR = 3.2; 95% CI = 1.34 to 7.62; p = 0.007). Multivariate analysis revealed lower Adjusted serum calcium levels as an independent predictor of poor outcome in acute ischemic stroke (RR = 6.47; 95%IC = 1.69 to 24.72; p = 0.006). Low Adjusted serum calcium level is an independent predictor of poor outcomes in patients with acute ischemic stroke. Keywords: adjusted calcium, poor outcome, acute ischemic stroke. 1. Introduction Stroke is a major problem in both developed and developing countries. Stroke, as the leading cause of global death and disability, has affected more than 700,000 people in Amerikca.[1] The overall incidence of stroke in Asia is 116- 483/100.000 per year.[2] Stroke often results in disability and causes emotional distress and economic problems for patients and their families.[3] Calcium is an essential element for various biological processes from fertilization to death. The serum calcium is divided into three fractions: 50% of calcium ions in the active form, 40% bound to serum proteins, principally albumin and 10% bound to anions such as bicarbonate and citrate. 4 Calcium plays an important role in the pathogenesis of ischemic cell death. Accumulation of intracellular calcium causes the death of neurons that form the basic pathomechanism of ischemic stroke driven by exotoxicity. [4-6] Measurement of total calcium level is affected by level of total protein, especially albumin. Hypocalcemia often occurs due to a decrease in the fraction bound to albumin, although active calcium levels may be normal.[4,7] Hypoalbuminemia is commonly found in patients with stroke, giving a predictor of poor outcomes.[4] Alteration of protein levels, can cause changes in total calcium without affecting ionized calcium physiologically and clinically, thus, the total calcium serum adjustment to albumin is very important when trying to determine the value of normal calcium.[8-10] For this reason, the adjusted calcium is a better parameter to evaluate the effect of calcium on the cell when direct ionized calcium level measurement are is available.[10] This study aims to determine whether low Adjusted serum calcium level can be used as a predictor of poor outcome during treatment in patients with acute ischemic stroke. 2. Subject and Methods Study Design We used observational prospective cohort in subjects with acute ischemic stroke. Samples were taken with consecutive non-random sampling method. This research was conducted in the Department of Neurology Faculty of Medicine, University of Udayana/Sanglah General Hospital, Denpasar, from December 2016 - February 2017. Data Collection Patients with acute ischemic stroke with onset ≤ 72 hours and ≥ 25 years old who were willing to sign informed consent included into this study. The exclusion criteria were: patients with stroke who were not confirmed by a brain CT scan; clinical symptoms of posterior circulation; history of prior stroke; history of other brain disorders; history of acute myocardial infarction; history of blood transfusions; history of malignancy; stroke patients with impaired parathyroid hormone and thyroid hormone, hypercalcemia, impaired liver function and kidney function; acute infectious disease; autoimmune disease; and pancreatitis. On admission, the total calcium and albumin serum levels were measured, and using these data the Adjusted serum calcium level was calculated. The NIHSS score was used to measure the severity of each subject, and was taken on admission and day-7 th of the treatment. Paper ID: ART20172455 DOI: 10.21275/ART20172455 638