Abstract：
Calcium can be measured as ionised (Ca-ionised) or albumin-adjusted total calcium (Ca-albumin). Current clinical guidelines predominantly utilise Ca-albumin, despite Ca-ionised being the gold standard. Discrepancies can occur between these measurement modalities and can lead to clinical dilemmas. It remains unclear how large these discrepancies are in older patients. This study investigated the discrepancies between Ca-ionised and Ca-albumin in geriatric patients.
This is an observational study of all geriatric patients (n = 876) in the Jeroen Bosch Hospital (January 2018 and January 2021) in whom both Ca-ionised and Ca-albumin were measured. Misclassification of calcaemic state (i.e. low, normal or high) was calculated (percentages), the measure of agreement was described using Cohen\'s Kappa and for the continuous data Pearson\'s correlation coefficient was used. Relevant categories of age and renal function were considered for effect modification effects and studied by interaction terms in a regression model.
In one-third of the measurements, there was a misclassification. Ca-albumin measurements failed to identify 28% of hypocalcaemia. In 3.5%, hypercalcemia based on Ca-albumin was not confirmed by Ca-ionised. The correlation coefficient between Ca-ionised and Ca-albumin was 0.743 (P = 0.01) and measure of agreement by Kappa was 0.213 (P < 0.001). In the oldest old (≥ 85 years) and patients with eGFR <30 ml/min/1.73 m2 ,the agreement by Kappa was lower, with values of 0.192 and 0.104, respectively.
There is a discrepancy between Ca-albumin and Ca-ionised in one-third of the geriatric patients, leading to clinical dilemmas. In the oldest old and patients with renal dysfunction, this problem is most pronounced.
This is an observational study of all geriatric patients (n = 876) in the Jeroen Bosch Hospital (January 2018 and January 2021) in whom both Ca-ionised and Ca-albumin were measured. Misclassification of calcaemic state (i.e. low, normal or high) was calculated (percentages), the measure of agreement was described using Cohen\'s Kappa and for the continuous data Pearson\'s correlation coefficient was used. Relevant categories of age and renal function were considered for effect modification effects and studied by interaction terms in a regression model.
In one-third of the measurements, there was a misclassification. Ca-albumin measurements failed to identify 28% of hypocalcaemia. In 3.5%, hypercalcemia based on Ca-albumin was not confirmed by Ca-ionised. The correlation coefficient between Ca-ionised and Ca-albumin was 0.743 (P = 0.01) and measure of agreement by Kappa was 0.213 (P < 0.001). In the oldest old (≥ 85 years) and patients with eGFR <30 ml/min/1.73 m2 ,the agreement by Kappa was lower, with values of 0.192 and 0.104, respectively.
There is a discrepancy between Ca-albumin and Ca-ionised in one-third of the geriatric patients, leading to clinical dilemmas. In the oldest old and patients with renal dysfunction, this problem is most pronounced.
摘要：
背景:钙可以测量为电离的(Ca-电离的)或白蛋白调节的总钙(Ca-白蛋白)。目前的临床指南主要使用钙白蛋白，尽管钙离子是黄金标准。这些测量方式之间可能存在差异，并可能导致临床困境。目前尚不清楚这些差异在老年患者中有多大。这项研究调查了老年患者钙离子和钙白蛋白之间的差异。
方法：这是一项针对JeroenBosch医院（2018年1月和2021年1月）的所有老年患者（n=876）的观察性研究，其中测量了钙离子和钙白蛋白。钙血症状态分类错误(即低，正常或高)计算(百分比)，一致性度量使用Cohen的Kappa描述,对于连续数据使用Pearson的相关系数。考虑了年龄和肾功能的相关类别以进行效果调节，并在回归模型中通过相互作用项进行了研究。
结果：在三分之一的测量中，有一个错误分类。钙白蛋白测量未能确定28％的低钙血症。在3.5%中，钙离子未证实基于钙白蛋白的高钙血症.钙离子与钙白蛋白的相关系数为0.743（P=0.01），Kappa的一致性为0.213（P<0.001）。在年龄最大（≥85岁）和eGFR<30ml/min/1.73m2的患者中，卡帕的协议更低，值分别为0.192和0.104。
结论：在三分之一的老年患者中，钙白蛋白和钙离子之间存在差异，导致临床困境。在最年长的老年人和肾功能不全患者中，这个问题最为突出。
方法：这是一项针对JeroenBosch医院（2018年1月和2021年1月）的所有老年患者（n=876）的观察性研究，其中测量了钙离子和钙白蛋白。钙血症状态分类错误(即低，正常或高)计算(百分比)，一致性度量使用Cohen的Kappa描述,对于连续数据使用Pearson的相关系数。考虑了年龄和肾功能的相关类别以进行效果调节，并在回归模型中通过相互作用项进行了研究。
结果：在三分之一的测量中，有一个错误分类。钙白蛋白测量未能确定28％的低钙血症。在3.5%中，钙离子未证实基于钙白蛋白的高钙血症.钙离子与钙白蛋白的相关系数为0.743（P=0.01），Kappa的一致性为0.213（P<0.001）。在年龄最大（≥85岁）和eGFR<30ml/min/1.73m2的患者中，卡帕的协议更低，值分别为0.192和0.104。
结论：在三分之一的老年患者中，钙白蛋白和钙离子之间存在差异，导致临床困境。在最年长的老年人和肾功能不全患者中，这个问题最为突出。
