Prognostic Implications of Initial Ionized Calcium Levels for Short-Term Mortality in Severely Ill Pediatric Patients with Sepsis

Overview

This study investigates the relationship between admission ionized calcium (iCa) levels and 28-day mortality in pediatric patients with sepsis. It finds that hypocalcemia is common and significantly associated with increased mortality risk, suggesting that iCa may serve as a valuable prognostic biomarker.

Background

Sepsis is a leading cause of morbidity and mortality in pediatric intensive care units (PICUs), necessitating effective risk assessment strategies. Current severity scoring systems can be complex and delayed, highlighting the need for simpler, rapid biomarkers. Disruptions in calcium homeostasis, particularly hypocalcemia, are frequently observed in critically ill patients, yet their prognostic significance in pediatric sepsis remains unclear.

Data Highlights

Key Findings

• Hypocalcemia was present in 50.8% of the studied pediatric sepsis patients.
• Each 0.1 mmol/L decrease in iCa was associated with a 55% increased risk of 28-day mortality.
• The 28-day mortality rate was significantly higher in hypocalcemic patients (19.2%) compared to normocalcemic patients (3.4%).
• Admission iCa levels provided moderate discrimination for predicting 28-day mortality (AUC 0.734).
• Incorporating iCa into risk assessments improved reclassification of mortality risk.
• Stronger associations between iCa and mortality were observed in patients with lactate levels ≤4 mmol/L.

Clinical Implications

Monitoring admission iCa levels in pediatric patients with sepsis may enhance early risk stratification and inform clinical decision-making. Given its correlation with mortality, iCa could be a useful biomarker in the management of critically ill children.

Conclusion

The study underscores the independent association of decreased admission iCa levels with increased short-term mortality in pediatric sepsis. Utilizing iCa as a rapid biomarker may improve outcomes through better risk assessment.

Related Resources & Content

1. Frontiers | Prognostic Value of Admission Ionized Calcium for Short-Term Mortality in Critically Ill Children With Sepsis: A Single-Center Retrospective Cohort Study
2. Infection — The Relationship Between Serum Osmolality and 28-Day Mortality Rates in Sepsis Patients: Findings from a Retrospective Cohort Analysis
3. Intensive Care Medicine — Evaluating the Predictive Value of Age-Modified SOFA, SIRS, PELOD-2, and qSOFA for In-Hospital Mortality in Pediatric Patients with Suspected Infections in the ICU
4. Pediatric Cardiology — Assessing the Prognostic Role of Neuron-Specific Enolase and S100 Calcium-Binding Protein in Predicting Mortality Among Children Following Cardiac Arrest Resuscitation
5. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children | SCCM
6. Frontiers in Medicine — Hematologic and metabolic indices for predicting 28-day mortality in sepsis patients: a retrospective intensive care cohort study
7. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children | SCCM
8. Frontiers | Prognostic Value of Admission Ionized Calcium for Short-Term Mortality in Critically Ill Children With Sepsis: A Single-Center Retrospective Cohort Study
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