The Worth of Total Calcium Levels Adjusted By Various Formulae in the Di-agnosis of Hypocalcemia

Tuba Batur; Halil İbrahim Akbay; Erdem Çokluk

doi:10.46332/aemj.1039915

Research Article

The Worth of Total Calcium Levels Adjusted By Various Formulae in the Di-agnosis of Hypocalcemia

Year 2023, Volume: 7 Issue: 2, 177 - 182, 07.08.2023

Tuba Batur Halil İbrahim Akbay Erdem Çokluk

https://doi.org/10.46332/aemj.1039915

Abstract

Purpose: The aim was to evaluate the diagnostic accuracy of the corrected total calcium (cCa) calculated with different formulas in the diagnosis of hypocalcemia.

Materials and Methods: Whole blood free calcium and serum total calcium levels of a total of 410 individuals were evaluated.cCa levels were calculated using the Modified Orrell, Orrell, Payne, Berry, and James methods. In each of the hypoalbuminemia and normoalbuminemia groups, the diagnostic performance parameters of measured total calcium and cCa in the diagnosis of hypocalcemia were calculated. Hypocalcemia was diagnosed by measuring free calcium levels. The difference between the groups was analyzed using the Mann-Whitney.U test.A Spearman correlation analysis was performed to determine the correlation between free calcium and total Ca levels.

Results: In the diagnosis of hypocalcemia, the test with the highest sensitivity in the hypoalbuminemia group was the total calcium test, measured at a rate of 80.3%. The sensitivity was <60% in all cCa levels calculated with the five different formulas. Sensitivity rates were <40% for measured and all cCa concentrations in the normoalbuminemia group.In the hypoalbuminemia group, a low level of correlation was observed between free calcium and each calcium level calculated by the Modified Orrell, Payne, Orrell, Berry, and James method (p<0.001,r=0.240;0.258;0.230;0.247;0.193).

Conclusion: The formulas used to calculate the cCa concentration need improvement. cCa did not replace free calcium,and cCa did not outperform the total calcium level in the diagnosis of hypocalcemia.We are of the opinion that it is not reliable to comment on the free calcium levels by cCa concentration.

Keywords

corrected calcium, free calcium, hypocalcemia, diagnostic performance

References

1. Wieliczko M, Matuszkiewicz-Rowińska J. Homeostaza wapnia Calcium homeostasis. Wiadomosci lek. 2013;66(4):299-302.
2. Yu E, Sharma S. Physiology, Calcium. USA;StatPearls Publishing;2021.
3. Stewart TA, Davis FM. An element for development: Calcium signaling in mammalian reproduction and development. Biochim biophys acta-mol cell res. 2019; 1866(7):1230-1238.
4. Dickerson RN, Alexander KH, Minard G, et al. Accuracy of methods to estimate ionized and "corrected" serum calcium concentrations in critically ill multiple trauma patients receiving specialized nutrition support. J parenter enteral nutr. 2004;28(3):133-141.
5. Mateu-de Antonio J. New Predictive Equations for Serum Ionized Calcium in Hospitalized Patients. Med princ pract. 2016;25(3):219-226.
6. Ladenson JH, Lewis JW, Boyd JC. Failure of total calcium corrected for protein, albumin, and pH to correctly assess free calcium status. J clin endocrinol metabol.1978;46(6):986-993.
7. Endres DB, Rude RK. Mineral and bone metabolism. In: BurtisCA, Ashwood ER, eds.Tietz Textbook of Clinical Chemistry.Philadelphia: W. B. Saunders Company. 1999:1370-1415.
8. Orrell DH. Albumin as an aid to the interpretation of serum calcium. Clin chim acta. 1971;35(2):483-489.
9. Payne RB, Little AJ, Williams RB, Milner JR. Interpretation of serum calcium in patients with abnormal serum proteins. BMJ. 1973;4(5893):643-646.
10. Berry EM, Gupta MM, Turner SJ, et al. Variation in plasma calcium with induced changes in plasma specific gravity, total protein, and albumin. BMJ. 1973;4(5893):640-643.
11. James MT, Zhang J, Lyon AW, et al. Derivation and internal validation of an equation for albumin-adjusted calcium. BMC clin pathol. 2008;8(1):1-6.
12. Alan HB. Tietz Clinical Guide to Laboratory Tests. 4th ed. Elsevier Saunder (2006).
13. Hu ZD, Huang YL, Wang MY, et al. Predictive accuracy of serum total calcium for both critically high and critically low ionized calcium in critical illness. J clin lab anal.2018;32(9):e22589.
14. Link A, Klingele M, Speer T, et al. Total-to-ionized calcium ratio predicts mortality in continuous renal replacement therapy with citrate anticoagulation in critically ill patients. Crit care. 2012;16(3):R97.
15. Mir AA, Goyal B, Datta SK, et al. Comparison Between Measured and Calculated Free Calcium Values at Different Serum Albumin Concentrations. J lab phys. 2016;8(2):71-76.
16. Smith JD, Wilson S, Schneider HG. Misclassification of Calcium Status Based on Albumin-Adjusted Calcium: Studies in a Tertiary Hospital Setting. Clin chem. 2018;64(12):1713-1722.
17. Gøransson LG, Skadberg Ø, Bergrem H. Albumin-corrected or ionized calcium in renal failure? What to measure?. Nephrol. Dial. Transplant. 2005;20(10): 2126-2129.
18. Gauci C, Moranne O, Fouqueray B, et al. Pitfalls of measuring total blood calcium in patients with CKD. J Am Soc Nephrol. 2008;19(8):1592–1598.
19. Slomp J, van der Voort PH, Gerritsen RT, et al. Albumin-adjusted calcium is not suitable for diagnosis of hyper- and hypocalcemia in the critically ill. Crit care med. 2003;31(5):1389–1393.
20. Lian IA, Åsberg A. Should total calcium be adjusted for albumin? A retrospective observational study of laboratory data from central Norway. BMJ open. 2018;8(4):e017703.
21. Sudhakar T, Kandi S, Reddy KB, et al. Impedance of Results Using Lithium Heparin to Plain Tubes for Ionized Calcium. Am J Biomed Res. 2014;2(4):67-69.

Çeşitli Formüllerle Hesaplanan Düzeltilmiş Total Kalsiyum Düzeylerinin Hipokalsemi Tanısındaki Değeri

Year 2023, Volume: 7 Issue: 2, 177 - 182, 07.08.2023

Tuba Batur Halil İbrahim Akbay Erdem Çokluk

https://doi.org/10.46332/aemj.1039915

Abstract

Amaç: Farklı formüllerle hesaplanan düzeltilmiş kalsiyum düzeylerinin hipokalsemi açısından tanısal doğruluğunun araştırılması amaçlandı.

Araçlar ve Yöntem: 410 bireye ait tam kan serbest kalsiyum ve serum total kalsiyum düzeyi değerlendirildi. Düzeltilmiş kalsiyum düzeyleri Modifiye Orrell, Orrell, Payne, Berry ve James metoduyla hesaplandı. Hipoalbuminemi ve normoalbuminemi grupları oluşturularak herbir grupta ölçülen ve hesaplanan total kalsiyum düzeyleri için tanısal performans parametreleri incelendi. Hipokalsemi tanısında serbest kalsiyum düzeyleri referans alındı. Gruplar arasındaki farklar Mann-Whitney U testiyle incelendi. Serbest kalsiyum ile ölçülen ve hesaplanan total kalsiyum düzeyleri arasındaki ilişki Spearman korelasyon analizi ile incelendi.

Bulgular: Hipoalbuminemi grubunda en yüksek sensitiviteye sahip test %80.3 oranıyla total kalsiyum testiydi. Tüm düzeltilmiş kalsiyum düzeylerinin sensitivitesi <%60’ tı. Normoalbuminemi grubunda ise ölçülen ve hesaplanan bütün düzeltilmiş kalsiyum düzeyleri için <%40’tı. Hipoalbüminemi grubunda, Modifiye Orrell, Payne, Orrell, Berry ve James yöntemi ile hesaplanan her bir kalsiyum düzeyi ile serbest kalsiyum arasında düşük düzeyde bir korelasyon gözlendi (p<0.001, r=0.240; 0.258; 0.230; 0.247; 0.193).

Sonuç: Düzeltilmiş kalsiyum konsantrasyonunun hesaplanmasında kullanılan formüllerin geliştirilmeye ihtiyacı vardır. Düzeltilmiş kalsiyum düzeyleri serbest kalsiyumun yerini alamadığı gibi, ölçülen total kalsiyum düzeylerinden daha iyi performans sergileyemedi. Düzeltilmiş kalsiyum düzeyleriyle serbest kalsiyum konsantrasyonu konusunda yorum yapmanın güvenilir olmadığı kanaatindeyiz.

Keywords

düzeltilmiş kalsiyum, serbest kalsiyum, hipokalsemi, tanısal performans

References

1. Wieliczko M, Matuszkiewicz-Rowińska J. Homeostaza wapnia Calcium homeostasis. Wiadomosci lek. 2013;66(4):299-302.
2. Yu E, Sharma S. Physiology, Calcium. USA;StatPearls Publishing;2021.
3. Stewart TA, Davis FM. An element for development: Calcium signaling in mammalian reproduction and development. Biochim biophys acta-mol cell res. 2019; 1866(7):1230-1238.
4. Dickerson RN, Alexander KH, Minard G, et al. Accuracy of methods to estimate ionized and "corrected" serum calcium concentrations in critically ill multiple trauma patients receiving specialized nutrition support. J parenter enteral nutr. 2004;28(3):133-141.
5. Mateu-de Antonio J. New Predictive Equations for Serum Ionized Calcium in Hospitalized Patients. Med princ pract. 2016;25(3):219-226.
6. Ladenson JH, Lewis JW, Boyd JC. Failure of total calcium corrected for protein, albumin, and pH to correctly assess free calcium status. J clin endocrinol metabol.1978;46(6):986-993.
7. Endres DB, Rude RK. Mineral and bone metabolism. In: BurtisCA, Ashwood ER, eds.Tietz Textbook of Clinical Chemistry.Philadelphia: W. B. Saunders Company. 1999:1370-1415.
8. Orrell DH. Albumin as an aid to the interpretation of serum calcium. Clin chim acta. 1971;35(2):483-489.
9. Payne RB, Little AJ, Williams RB, Milner JR. Interpretation of serum calcium in patients with abnormal serum proteins. BMJ. 1973;4(5893):643-646.
10. Berry EM, Gupta MM, Turner SJ, et al. Variation in plasma calcium with induced changes in plasma specific gravity, total protein, and albumin. BMJ. 1973;4(5893):640-643.
11. James MT, Zhang J, Lyon AW, et al. Derivation and internal validation of an equation for albumin-adjusted calcium. BMC clin pathol. 2008;8(1):1-6.
12. Alan HB. Tietz Clinical Guide to Laboratory Tests. 4th ed. Elsevier Saunder (2006).
13. Hu ZD, Huang YL, Wang MY, et al. Predictive accuracy of serum total calcium for both critically high and critically low ionized calcium in critical illness. J clin lab anal.2018;32(9):e22589.
14. Link A, Klingele M, Speer T, et al. Total-to-ionized calcium ratio predicts mortality in continuous renal replacement therapy with citrate anticoagulation in critically ill patients. Crit care. 2012;16(3):R97.
15. Mir AA, Goyal B, Datta SK, et al. Comparison Between Measured and Calculated Free Calcium Values at Different Serum Albumin Concentrations. J lab phys. 2016;8(2):71-76.
16. Smith JD, Wilson S, Schneider HG. Misclassification of Calcium Status Based on Albumin-Adjusted Calcium: Studies in a Tertiary Hospital Setting. Clin chem. 2018;64(12):1713-1722.
17. Gøransson LG, Skadberg Ø, Bergrem H. Albumin-corrected or ionized calcium in renal failure? What to measure?. Nephrol. Dial. Transplant. 2005;20(10): 2126-2129.
18. Gauci C, Moranne O, Fouqueray B, et al. Pitfalls of measuring total blood calcium in patients with CKD. J Am Soc Nephrol. 2008;19(8):1592–1598.
19. Slomp J, van der Voort PH, Gerritsen RT, et al. Albumin-adjusted calcium is not suitable for diagnosis of hyper- and hypocalcemia in the critically ill. Crit care med. 2003;31(5):1389–1393.
20. Lian IA, Åsberg A. Should total calcium be adjusted for albumin? A retrospective observational study of laboratory data from central Norway. BMJ open. 2018;8(4):e017703.
21. Sudhakar T, Kandi S, Reddy KB, et al. Impedance of Results Using Lithium Heparin to Plain Tubes for Ionized Calcium. Am J Biomed Res. 2014;2(4):67-69.

There are 21 citations in total.

Details

Primary Language	English
Subjects	Clinical Sciences, Clinical Sciences (Other)
Journal Section	Original Articles
Authors	Tuba Batur 0000-0002-8225-3153 Halil İbrahim Akbay 0000-0002-4303-7837 Erdem Çokluk 0000-0002-6205-5109
Early Pub Date	July 5, 2023
Publication Date	August 7, 2023
Published in Issue	Year 2023 Volume: 7 Issue: 2

Cite

APA	Batur, T., Akbay, H. İ., & Çokluk, E. (2023). The Worth of Total Calcium Levels Adjusted By Various Formulae in the Di-agnosis of Hypocalcemia. Ahi Evran Medical Journal, 7(2), 177-182. https://doi.org/10.46332/aemj.1039915
AMA	Batur T, Akbay Hİ, Çokluk E. The Worth of Total Calcium Levels Adjusted By Various Formulae in the Di-agnosis of Hypocalcemia. Ahi Evran Med J. August 2023;7(2):177-182. doi:10.46332/aemj.1039915
Chicago	Batur, Tuba, Halil İbrahim Akbay, and Erdem Çokluk. “The Worth of Total Calcium Levels Adjusted By Various Formulae in the Di-Agnosis of Hypocalcemia”. Ahi Evran Medical Journal 7, no. 2 (August 2023): 177-82. https://doi.org/10.46332/aemj.1039915.
EndNote	Batur T, Akbay Hİ, Çokluk E (August 1, 2023) The Worth of Total Calcium Levels Adjusted By Various Formulae in the Di-agnosis of Hypocalcemia. Ahi Evran Medical Journal 7 2 177–182.
IEEE	T. Batur, H. İ. Akbay, and E. Çokluk, “The Worth of Total Calcium Levels Adjusted By Various Formulae in the Di-agnosis of Hypocalcemia”, Ahi Evran Med J, vol. 7, no. 2, pp. 177–182, 2023, doi: 10.46332/aemj.1039915.
ISNAD	Batur, Tuba et al. “The Worth of Total Calcium Levels Adjusted By Various Formulae in the Di-Agnosis of Hypocalcemia”. Ahi Evran Medical Journal 7/2 (August 2023), 177-182. https://doi.org/10.46332/aemj.1039915.
JAMA	Batur T, Akbay Hİ, Çokluk E. The Worth of Total Calcium Levels Adjusted By Various Formulae in the Di-agnosis of Hypocalcemia. Ahi Evran Med J. 2023;7:177–182.
MLA	Batur, Tuba et al. “The Worth of Total Calcium Levels Adjusted By Various Formulae in the Di-Agnosis of Hypocalcemia”. Ahi Evran Medical Journal, vol. 7, no. 2, 2023, pp. 177-82, doi:10.46332/aemj.1039915.
Vancouver	Batur T, Akbay Hİ, Çokluk E. The Worth of Total Calcium Levels Adjusted By Various Formulae in the Di-agnosis of Hypocalcemia. Ahi Evran Med J. 2023;7(2):177-82.

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