{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T15:36:50Z","timestamp":1776353810492,"version":"3.51.2"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T00:00:00Z","timestamp":1639180800000},"content-version":"vor","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pulm Med"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute pulmonary embolism (PE) is a common cause for hospitalization associated with significant mortality and morbidity. Disorders of calcium metabolism are a frequently encountered medical problem. The effect of hypocalcemia is not well defined on the outcomes of patients with PE. We aimed to identify the prognostic value of hypocalcemia in hospitalized PE patients utilizing the 2017 Nationwide Inpatient Sample (NIS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective study, we selected patients with a primary diagnosis of Acute PE using ICD 10 codes. They were further stratified based on the presence of hypocalcemia. We primarily aimed to compare in-hospital mortality for PE patients with and without hypocalcemia. We performed multivariate logistic regression analysis to adjust for potential confounders. We also used propensity\u2010matched cohort of patients to compare mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the 2017 NIS, 187,989 patients had a principal diagnosis of acute PE. Among the above study group, 1565 (0.8%) had an additional diagnosis of hypocalcemia. 12.4% of PE patients with hypocalcemia died in the hospital in comparison to 2.95% without hypocalcemia. On multivariate regression analysis, PE and hypocalcemia patients had 4 times higher odds (aOR-4.03, 95% CI 2.78\u20135.84, p\u2009&lt;\u20090.001) of in-hospital mortality compared to those with only PE. We observed a similarly high odds of mortality (aOR\u2009=\u20094.4) on 1:1 propensity-matched analysis. The incidence of acute kidney injury (aOR\u2009=\u20092.62, CI 1.95\u20133.52, p\u2009&lt;\u20090.001), acute respiratory failure (a0R\u2009=\u20091.84, CI 1.42\u20132.38, p\u2009&lt;\u20090.001), sepsis (aOR\u2009=\u20094.99, CI 3.08\u20138.11, p\u2009&lt;\u20090.001) and arrhythmias (aOR\u2009=\u20092.63, CI 1.99\u20133.48, p\u2009&lt;\u20090.001) were also higher for PE patients with hypocalcemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PE patients with hypocalcemia have higher in-hospital mortality than those without hypocalcemia. The in-hospital complications were also higher, along with longer length of stay.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12890-021-01784-0","type":"journal-article","created":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T06:04:47Z","timestamp":1639202687000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Association of hypocalcemia with in-hospital mortality and complications in patients with acute pulmonary embolism: results from the 2017 Nationwide Inpatient Sample"],"prefix":"10.1186","volume":"21","author":[{"given":"Mukunthan","family":"Murthi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hafeez","family":"Shaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zain","family":"El-amir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sujitha","family":"Velagapudi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdul","family":"Jamil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farah","family":"Wani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramtej","family":"Atluri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akshay","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asim","family":"Kichloo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,12,11]]},"reference":[{"issue":"4 Suppl","key":"1784_CR1","doi-asserted-by":"publisher","first-page":"S495","DOI":"10.1016\/j.amepre.2009.12.017","volume":"38","author":"MG Beckman","year":"2010","unstructured":"Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous thromboembolism: a public health concern. Am J Prev Med. 2010;38(4 Suppl):S495-501.","journal-title":"Am J Prev Med"},{"key":"1784_CR2","volume-title":"Coagulation and blood transfusion developments in hematology and immunology","author":"ME Mikaelsson","year":"1991","unstructured":"Mikaelsson ME. The role of calcium in coagulation and anticoagulation. In: Sibinga CTS, Das PC, Mannucci PM, editors. Coagulation and blood transfusion developments in hematology and immunology, vol. 26. Boston: Springer; 1991."},{"issue":"8","key":"1784_CR3","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1016\/j.cardfail.2015.04.015","volume":"21","author":"S Miura","year":"2015","unstructured":"Miura S, Yoshihisa A, Takiguchi M, Shimizu T, Nakamura Y, Yamauchi H, et al. Association of hypocalcemia with mortality in hospitalized patients with heart failure and chronic kidney disease. J Card Fail. 2015;21(8):621\u20137.","journal-title":"J Card Fail"},{"issue":"1","key":"1784_CR4","doi-asserted-by":"publisher","first-page":"4418","DOI":"10.1038\/s41598-020-61459-4","volume":"10","author":"S Yamaguchi","year":"2020","unstructured":"Yamaguchi S, Hamano T, Doi Y, Oka T, Kajimoto S, Kubota K, et al. Hidden hypocalcemia as a risk factor for cardiovascular events and all-cause mortality among patients undergoing incident hemodialysis. Sci Rep. 2020;10(1):4418.","journal-title":"Sci Rep"},{"issue":"1","key":"1784_CR5","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1186\/s12931-020-01565-z","volume":"21","author":"X Wang","year":"2020","unstructured":"Wang X, Xiang Y, Zhang T, Yang Y, Sun X, Shi J. Association between serum calcium and prognosis in patients with acute pulmonary embolism and the optimization of pulmonary embolism severity index. Respir Res. 2020;21(1):298.","journal-title":"Respir Res"},{"key":"1784_CR6","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1016\/j.mehy.2006.07.047","volume":"68","author":"B Usta","year":"2007","unstructured":"Usta B, Gozdemir M, Turgut F, Sert H, Kanbay M, Demircioglu RI, et al. Does hypocalcemia trigger pulmonary embolism? Med Hypotheses. 2007;68:464\u20135.","journal-title":"Med Hypotheses"},{"issue":"5","key":"1784_CR7","doi-asserted-by":"publisher","first-page":"515","DOI":"10.4103\/0019-5049.144643","volume":"58","author":"S Palta","year":"2014","unstructured":"Palta S, Saroa R, Palta A. Overview of the coagulation system. Indian J Anaesth. 2014;58(5):515\u201323.","journal-title":"Indian J Anaesth"},{"issue":"11","key":"1784_CR8","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.1001\/jamaneurol.2016.2252","volume":"73","author":"A Morotti","year":"2016","unstructured":"Morotti A, Charidimou A, Phuah C-L, Jessel MJ, Schwab K, Ayres AM, et al. Association between serum calcium level and extent of bleeding in patients with intracerebral hemorrhage. JAMA Neurol. 2016;73(11):1285\u201390.","journal-title":"JAMA Neurol"},{"issue":"3","key":"1784_CR9","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1007\/s11914-017-0368-x","volume":"15","author":"KM Hill Gallant","year":"2017","unstructured":"Hill Gallant KM, Spiegel DM. Calcium balance in chronic kidney disease. Curr Osteoporos Rep. 2017;15(3):214\u201321.","journal-title":"Curr Osteoporos Rep"},{"issue":"10","key":"1784_CR10","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1530\/EC-18-0267","volume":"7","author":"M Duval","year":"2018","unstructured":"Duval M, Bach K, Masson D, Guimard C, Le Conte P, Trewick D. Is severe hypocalcemia immediately life-threatening? Endocr Connect. 2018;7(10):1067\u201374.","journal-title":"Endocr Connect"},{"issue":"1","key":"1784_CR11","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1007\/s12020-020-02541-9","volume":"71","author":"L di Filippo","year":"2021","unstructured":"di Filippo L, Formenti AM, Doga M, Frara S, Rovere-Querini P, Bosi E, et al. Hypocalcemia is a distinctive biochemical feature of hospitalized COVID-19 patients. Endocrine. 2021;71(1):9\u201313.","journal-title":"Endocrine"},{"issue":"9","key":"1784_CR12","doi-asserted-by":"publisher","first-page":"1224","DOI":"10.1016\/j.jiph.2020.05.029","volume":"13","author":"J Liu","year":"2020","unstructured":"Liu J, Han P, Wu J, Gong J, Tian D. Prevalence and predictive value of hypocalcemia in severe COVID-19 patients. J Infect Public Health. 2020;13(9):1224\u20138.","journal-title":"J Infect Public Health"},{"issue":"4","key":"1784_CR13","doi-asserted-by":"publisher","first-page":"e95204","DOI":"10.1371\/journal.pone.0095204","volume":"9","author":"Z Zhang","year":"2014","unstructured":"Zhang Z, Xu X, Ni H, Deng H. Predictive value of ionized calcium in critically ill patients: an analysis of a large clinical database MIMIC II. PLoS ONE. 2014;9(4):e95204.","journal-title":"PLoS ONE"},{"issue":"6","key":"1784_CR14","doi-asserted-by":"publisher","first-page":"1452","DOI":"10.1378\/chest.14-0059","volume":"146","author":"AJ Admon","year":"2014","unstructured":"Admon AJ, Seymour CW, Gershengorn HB, Wunsch H, Cooke CR. Hospital-level variation in ICU admission and critical care procedures for patients hospitalized for pulmonary embolism. Chest. 2014;146(6):1452\u201361.","journal-title":"Chest"},{"issue":"12","key":"1784_CR15","doi-asserted-by":"publisher","first-page":"2103","DOI":"10.1111\/jth.12420","volume":"11","author":"F Dentali","year":"2013","unstructured":"Dentali F, Riva N, Turato S, Grazioli S, Squizzato A, Steidl L, et al. Pulmonary embolism severity index accurately predicts long-term mortality rate in patients hospitalized for acute pulmonary embolism. J Thromb Haemost. 2013;11(12):2103\u201310.","journal-title":"J Thromb Haemost"},{"issue":"1","key":"1784_CR16","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1007\/s11239-019-01814-z","volume":"48","author":"P Wells","year":"2019","unstructured":"Wells P, Peacock WF, Fermann GJ, Coleman CI, Wang L, Baser O, et al. The value of sPESI for risk stratification in patients with pulmonary embolism. J Thromb Thrombolysis. 2019;48(1):149\u201357.","journal-title":"J Thromb Thrombolysis"},{"issue":"4","key":"1784_CR17","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1093\/eurheartj\/ehz405","volume":"41","author":"SV Konstantinides","year":"2019","unstructured":"Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing G-J, Harjola V-P, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Heart J. 2019;41(4):543\u2013603.","journal-title":"Eur Heart J"}],"container-title":["BMC Pulmonary Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-021-01784-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12890-021-01784-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-021-01784-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T06:06:31Z","timestamp":1639202791000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpulmmed.biomedcentral.com\/articles\/10.1186\/s12890-021-01784-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":17,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1784"],"URL":"https:\/\/doi.org\/10.1186\/s12890-021-01784-0","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2021.07.22.21260999","asserted-by":"object"}]},"ISSN":["1471-2466"],"issn-type":[{"value":"1471-2466","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]},"assertion":[{"value":"21 August 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 December 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 December 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"410"}}