{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T07:11:44Z","timestamp":1788592304001,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n The prognostic value of serum total calcium levels in critically ill patients with gastrointestinal bleeding remains unclear. This study aimed to investigate the association between baseline serum total calcium levels and mortality in critically ill patients with gastrointestinal bleeding using the electronic Intensive Care Unit (eICU)\u00a0database.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This retrospective cohort study was based on data collected from the eICU Collaborative Research Database in 2014 and 2015. Critically ill patients with gastrointestinal bleeding were included in this study. The exposure variable was the baseline serum calcium level. The primary outcome was hospital mortality, and the secondary outcome was intensive care unit (ICU) mortality. The non\u2010linear relationship between serum calcium levels and mortality was determined using a generalised additive model and smooth curve fitting, and we calculated the inflection point.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 10\u2009731 eligible patients were included. The hospital mortality and ICU mortality rates were 10.49% and 6.53% respectively. After adjusting for potential confounding factors, a U\u2010shaped relationship was detected between serum calcium levels and mortality. The first inflection point was 8.5 mg\/dL, and the second inflection point was 10.3 mg\/dL. On the left side of the first inflection point (serum calcium <8.5 mg\/dL), serum calcium levels were negatively associated with both hospital mortality (OR\u2009=\u20090.85, 95% CI 0.76\u20130.95) and ICU mortality (OR\u2009=\u20090.82, 95% CI 0.72\u20130.93). Conversely, on the right side of the second inflection point (serum calcium >10.3 mg\/dL), serum calcium levels were positively associated with both hospital mortality (OR\u2009=\u20091.57, 95% CI 1.05\u20132.34) and ICU mortality (OR\u2009=\u20091.56, 95% CI 1.02\u20132.38).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n A U\u2010shaped relationship between serum total calcium levels and mortality was observed in critically ill patients with gastrointestinal bleeding. Serum total calcium levels were associated with mortality in such patients, and this association has potential reference significance for risk assessment.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/imj.70592","type":"journal-article","created":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T06:24:42Z","timestamp":1788589482000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between serum calcium levels and mortality in critically ill patients with gastrointestinal bleeding: a retrospective cohort study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2535-7006","authenticated-orcid":false,"given":"Xiaoyu","family":"Zhao","sequence":"first","affiliation":[{"name":"The School of Clinical Medicine Guizhou Medical University Guiyang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology The Affiliated Hospital of Guizhou Medical University Guiyang China"},{"name":"Guizhou Provincial Key Laboratory for Digestive System Diseases The Affiliated Hospital of Guizhou Medical University Guiyang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuoan","family":"Qin","sequence":"additional","affiliation":[{"name":"Department of Cardiology The First People's Hospital of Changde City Changde China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology The Affiliated Hospital of Guizhou Medical University Guiyang China"},{"name":"Guizhou Provincial Key Laboratory for Digestive System Diseases The Affiliated Hospital of Guizhou Medical University Guiyang China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"a1","DOI":"10.1055\/s-0034-1393172","article-title":"Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) guideline","volume":"47","author":"Gralnek IM","year":"2015","journal-title":"Endoscopy"},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1136\/gutjnl-2018-317807","article-title":"Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology","volume":"68","author":"Oakland K","year":"2019","journal-title":"Gut"},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.bpg.2019.04.003","article-title":"Changing epidemiology and etiology of upper and lower gastrointestinal bleeding","volume":"42","author":"Oakland K","year":"2019","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"e_1_2_8_5_1","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1038\/ajg.2009.507","article-title":"Causes of mortality in patients with peptic ulcer bleeding: a prospective cohort study of 10,428 cases","volume":"105","author":"Sung JJ","year":"2010","journal-title":"Am J Gastroenterol"},{"key":"e_1_2_8_6_1","first-page":"654","article-title":"Acute lower GI bleeding in the UK: patient characteristics, interventions and outcomes in the first nationwide audit","volume":"67","author":"Oakland K","year":"2018","journal-title":"Gut"},{"key":"e_1_2_8_7_1","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1080\/00365521.2018.1454509","article-title":"Inhospital and delayed mortality after upper gastrointestinal bleeding: an analysis of risk factors in a prospective series","volume":"53","author":"Jim\u00e9nez\u2010Rosales R","year":"2018","journal-title":"Scand J Gastroenterol"},{"key":"e_1_2_8_8_1","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/S0272-6386(01)80116-5","article-title":"Hypocalcemia: a pervasive metabolic abnormality in the critically ill","volume":"37","author":"Zivin JR","year":"2001","journal-title":"Am J Kidney Dis"},{"key":"e_1_2_8_9_1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/0002-9343(88)90415-9","article-title":"Prevalence and clinical implications of hypocalcemia in acutely ill patients in a medical intensive care setting","volume":"84","author":"Desai TK","year":"1988","journal-title":"Am J Med"},{"key":"e_1_2_8_10_1","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/j.cardfail.2015.04.015","article-title":"Association of hypocalcemia with mortality in hospitalized patients with heart failure and chronic kidney disease","volume":"21","author":"Miura S","year":"2015","journal-title":"J Card Fail"},{"key":"e_1_2_8_11_1","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1002\/clc.22557","article-title":"Admission serum calcium levels improve the GRACE Risk Score prediction of hospital mortality in patients with acute coronary syndrome","volume":"39","author":"Yan SD","year":"2016","journal-title":"Clin Cardiol"},{"key":"e_1_2_8_12_1","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1111\/joim.12464","article-title":"Circulating calcium concentrations, vascular disease and mortality: a systematic review","volume":"279","author":"Reid IR","year":"2016","journal-title":"J Intern Med"},{"key":"e_1_2_8_13_1","doi-asserted-by":"crossref","first-page":"270","DOI":"10.7861\/clinmedicine.17-3-270","article-title":"Hypercalcaemia \u2010 presentation and management","volume":"17","author":"Turner JJO","year":"2017","journal-title":"Clin Med (Lond)"},{"key":"e_1_2_8_14_1","first-page":"377","article-title":"Hypercalcemia and cancer: differential diagnosis and treatment","volume":"68","author":"Zagzag J","year":"2018","journal-title":"CA Cancer J Clin"},{"key":"e_1_2_8_15_1","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-020-63334-8","article-title":"Increased risk of infection\u2010related and all\u2010cause death in hypercalcemic patients receiving hemodialysis: the Q\u2010cohort study","volume":"10","author":"Yamada S","year":"2020","journal-title":"Sci Rep"},{"key":"e_1_2_8_16_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0132788","article-title":"Calcium disorders in the emergency department: independent risk factors for mortality","volume":"10","author":"Sauter TC","year":"2015","journal-title":"PLoS One"},{"key":"e_1_2_8_17_1","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1080\/07435800.2018.1433200","article-title":"Impact of admission serum calcium levels on mortality in hospitalized patients","volume":"43","author":"Cheungpasitporn W","year":"2018","journal-title":"Endocr Res"},{"key":"e_1_2_8_18_1","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1007\/s12020-017-1353-y","article-title":"Calcium levels on admission and before discharge are associated with mortality risk in hospitalized patients","volume":"57","author":"Akirov A","year":"2017","journal-title":"Endocrine"},{"key":"e_1_2_8_19_1","doi-asserted-by":"crossref","DOI":"10.1038\/sdata.2018.178","article-title":"The eICU collaborative research database, a freely available multi\u2010center database for critical care research","volume":"5","author":"Pollard TJ","year":"2018","journal-title":"Sci Data"},{"key":"e_1_2_8_20_1","doi-asserted-by":"crossref","first-page":"805","DOI":"10.7326\/M19-1795","article-title":"Management of Nonvariceal Upper Gastrointestinal Bleeding: guideline recommendations from the international consensus group","volume":"171","author":"Barkun AN","year":"2019","journal-title":"Ann Intern Med"},{"key":"e_1_2_8_21_1","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1038\/ajg.2016.41","article-title":"ACG clinical guideline: Management of Patients with Acute Lower Gastrointestinal Bleeding","volume":"111","author":"Strate LL","year":"2016","journal-title":"Am J Gastroenterol"},{"key":"e_1_2_8_22_1","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.mce.2017.04.008","article-title":"The role of vitamin D in the endocrinology controlling calcium homeostasis","volume":"453","author":"Fleet JC","year":"2017","journal-title":"Mol Cell Endocrinol"},{"key":"e_1_2_8_23_1","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1007\/978-3-030-12457-1_42","article-title":"Extracellular Ca2+ in bone marrow","volume":"1131","author":"Hashimoto R","year":"2020","journal-title":"Adv Exp Med Biol"},{"key":"e_1_2_8_24_1","doi-asserted-by":"crossref","first-page":"2476","DOI":"10.1038\/s41598-021-81929-7","article-title":"Low serum calcium is associated with higher long\u2010term mortality in myocardial infarction patients from a population\u2010based registry","volume":"11","author":"Schmitz T","year":"2021","journal-title":"Sci Rep"},{"key":"e_1_2_8_25_1","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1515\/med-2020-0154","article-title":"Serum calcium levels correlates with coronary artery disease outcomes","volume":"15","author":"Wang M","year":"2020","journal-title":"Open Med (Wars)"},{"key":"e_1_2_8_26_1","doi-asserted-by":"crossref","first-page":"312","DOI":"10.5853\/jos.2019.00542","article-title":"Calcium intake and serum calcium level in relation to the risk of ischemic stroke: findings from the REGARDS study","volume":"21","author":"Dibaba DT","year":"2019","journal-title":"J Stroke"},{"key":"e_1_2_8_27_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.33549\/physiolres.933059","article-title":"Hypercalcemia. Pathophysiological aspects","volume":"65","author":"\u017dofkov\u00e1 I","year":"2016","journal-title":"Physiol Res"},{"key":"e_1_2_8_28_1","doi-asserted-by":"crossref","first-page":"54","DOI":"10.5853\/jos.2015.17.1.54","article-title":"Elevated calcium after acute ischemic stroke: association with a poor short\u2010term outcome and long\u2010term mortality","volume":"17","author":"Chung JW","year":"2015","journal-title":"J Stroke"},{"key":"e_1_2_8_29_1","doi-asserted-by":"crossref","DOI":"10.1186\/cc12756","article-title":"Assessment and clinical course of hypocalcemia in critical illness","volume":"17","author":"Steele T","year":"2013","journal-title":"Crit Care"},{"key":"e_1_2_8_30_1","article-title":"Association of Initial Serum Total Calcium Concentration with mortality in critical illness","volume":"2018","author":"Wang B","year":"2018","journal-title":"Biomed Res Int"},{"key":"e_1_2_8_31_1","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1016\/j.numecd.2018.01.013","article-title":"Serum calcium levels independently predict in\u2010hospital mortality in patients with acute myocardial infarction","volume":"28","author":"Shiyovich A","year":"2018","journal-title":"Nutr Metab Cardiovasc Dis"},{"key":"e_1_2_8_32_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-049957","article-title":"Altered serum calcium homeostasis independently predicts mortality in patients with acute coronary syndrome: a retrospective observational cohort study","volume":"11","author":"Su W","year":"2021","journal-title":"BMJ Open"},{"key":"e_1_2_8_33_1","doi-asserted-by":"crossref","DOI":"10.3390\/biom14020173","article-title":"The complex interplay between toxic Hallmark proteins, calmodulin\u2010binding proteins, ion channels, and receptors involved in calcium dyshomeostasis in neurodegeneration","volume":"14","author":"O'Day DH","year":"2024","journal-title":"Biomolecules"},{"key":"e_1_2_8_34_1","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1007\/s12291-019-00838-9","article-title":"Modes of calcium regulation in ischemic neuron","volume":"34","author":"Singh V","year":"2019","journal-title":"Indian J Clin Biochem"}],"container-title":["Internal Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.70592","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/imj.70592","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.70592","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T06:24:52Z","timestamp":1788589492000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.70592"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":33,"alternative-id":["10.1111\/imj.70592"],"URL":"https:\/\/doi.org\/10.1111\/imj.70592","archive":["Portico"],"relation":{},"ISSN":["1444-0903","1445-5994"],"issn-type":[{"value":"1444-0903","type":"print"},{"value":"1445-5994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,4]]},"assertion":[{"value":"2025-10-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"imj.70592"}}