Retrospective Cohort Study Of Hypercalcemia Inpatients

Hypercalcemia,one of the common clinical emergency, is often a manifestationof some serious diseases and malignant tumor. The mild conditions areasymptomatic and only found that the serum calcium level is increased inroutine screening, the serious conditions may lead to life-threateninghypercalcemic crisis.Therefore, systemic analysis clinical characteristics,treatment and prognosis of hypercalcemia caused by different etiology, has animportant significance for guiding the clinical decision-making. Thus, in orderto further improve the cure rate and survival rate in patients who havehypercalcemia, We medical workers should pay more attention to it.Objective： The research mainly analyzed clinical characteristics,treatment and prognosis of hypercalcemia caused by different etiology, anddiscussed the pathogenesis, there by improving the level of clinical diagnosisand treatment for this disease.Materials and methods: A retrospective hospital record study, whichenrolled67adult patients with hypercalcemia, was performed at all thedepartment of the Bethune First Hospital of Jilin University from January2011to November2014.All patients were divided into four groups according todifferent etiology of hypercalcemia: group1(malignant tumor), group2(primary hyperparathyroidism), group3(renal failure)and group4(otherdiseases).We ask for details and record the history of the inductees, includingsex, age, etiology, clinical manifestations, methods and length of treatment,related biochemical indicators(serum calcium, phosphorus, urea nitrogen,creatinine), albumin, alkaline phosphatase, uric acid, thyroid stimulatinghormone, free triiodothyronine, free thyroxine, parathyroid hormone, ECG, urinary color doppler ultrasound, related examination of the skeletalsystem,such as bone density, bone scan and X-ray/CT/MRI. For each groupanalyze clinical characteristics, treatment and prognosis of hypercalcemiacaused by different etiology.Statistical method: Use SPSSv22statistics softwarefor statistical analysis.Results：(1) The most common etiology of hypercalcemia inpatients wasmalignant tumors (62.7%), followed by primary hyperparathyroidism (14.9%),multiple myeloma is the most common in the malignancy associatedhypercalcemia (57.1%).(2) The corrected serum calcium level is higher thanbefore by correction formula, and the difference was statistically significant (P<0.01).(3) The order of serum calcium level of four groups is: group2> group1> group3> group4, but the difference was not statistically significant (P>0.05); the incidence of hypercalcemic crisis was the highest in group2(40%).(4) In the study,more than80%of patients accompanied with clinicalmanifestations of different systems, the most common was muscle and nervesystem symptoms (59.7%), the rest followed by of the digestive systemsymptoms (50.7%), skeletal system symptoms (49.3%), over half of patientsaccompanied with multiple (2or more) system symptoms.(5) Nearly half ofpatients accompanied with the skeletal system symptoms in this study, nearly1/3patients were confirmed accompanied with skeletal system lesions byskeletal system examination; fracture, osteoporosis were common skeletalsystem lesions.(6)In mild, moderate and severe hypercalcemia patients, muscleand nerve system symptoms were the most common clinical manifestations, thenumber of patients accompaning with multiple systems was increasing as theserum calcium level.(7)In addition to fluid infusion and diuretic, calcitonin wasthe most commonly used drugs for the treatment of hypercalcemia (56.7%), buthemodialysis/filtration/perfusion is the most commonly used method in group3 (66.7%).(8) In the study, the proportion that serum calcium decreased to thenormal level within3days was nearly1/3, within a week was more than half;the group1had the highest mortality (14.6%); but the difference was notstatistically significant (P>0.05).Conclusions：(1) The most common etiology of hypercalcemia inpatientswas malignant tumors (62.7%), multiple myeloma is the most common in themalignancy associated hypercalcemia (57.1%).(2) The corrected serumcalcium level is higher than before by correction formula, but the serumcalcium level caused by different etiology was not significant difference.(3)More than80%of patients accompanied with clinical manifestations ofdifferent systems, muscle and nerve system symptoms, digestive systemsymptoms, skeletal system symptoms were common, and used to accompanywith multiple (2or more) system symptoms.(4) In addition to fluid infusionand diuretic, calcitonin was the most commonly used drugs for the treatment ofhypercalcemia.(5)Malignancy associated hypercalcemia had the poor prognosis,and the mortality is high.(6) Clinicians should pay more attention tohypercalcemia, and further improve the relevant diagnostic tests.