{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T16:17:58Z","timestamp":1765383478706,"version":"3.46.0"},"reference-count":58,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Despite advances in post-cardiac arrest care, mortality and poor neurological outcomes remain common after out-of-hospital cardiac arrest (OHCA). Calcium imbalance is characteristic of post-cardiac arrest syndrome, but its prognostic role is unclear. We retrospectively analyzed 421 OHCA patients treated with targeted temperature management (TTM) (2011\u20132023). pH-adjusted ionized calcium levels were measured at 0, 12, 24, 48, and 72 h after return of spontaneous circulation (ROSC). Associations with 30-day neurological outcomes and mortality were assessed using multivariable logistic regression with two-stage maximum likelihood estimation. Higher baseline-adjusted ionized calcium levels were significantly associated with better neurological outcomes (Cerebral Performance Category 1\u20132) and lower 30-day mortality, regardless of calcium infusion or clinical covariates. Each 0.01-unit increase corresponded to 17% lower odds of unfavorable neurological outcome (odds ratio [OR], 0.83; 95% confidence interval [CI], 0.76\u20130.90) and 10% lower mortality (OR, 0.90; 95% CI, 0.84\u20130.96). Incorporating longitudinal calcium measurements improved predictive accuracy, raising the area under the curve for neurological outcomes from 0.843 to 0.919. Early post-ROSC ionized calcium levels were independently associated with neurological outcomes and mortality in patients with OHCA treated with TTM. Serial ionized calcium monitoring may serve as a prognostic marker, warranting prospective evaluation of therapeutic implications.<\/jats:p>","DOI":"10.3390\/life15121889","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T16:11:18Z","timestamp":1765383078000},"page":"1889","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Serum Ionized Calcium Levels and Neurological Outcomes in Patients with Out-of-Hospital Cardiac Arrest"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0083-4167","authenticated-orcid":false,"given":"Shin Young","family":"Park","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4973-9792","authenticated-orcid":false,"given":"Hyun-Soo","family":"Zhang","sequence":"additional","affiliation":[{"name":"Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7033-766X","authenticated-orcid":false,"given":"Incheol","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2074-6745","authenticated-orcid":false,"given":"Je Sung","family":"You","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1543-4664","authenticated-orcid":false,"given":"Yoo Seok","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1007\/s00134-014-3252-5","article-title":"Characteristics and prognosis of sudden cardiac death in Greater Paris: Population-based approach from the Paris Sudden Death Expertise Center (Paris-SDEC)","volume":"40","author":"Bougouin","year":"2014","journal-title":"Intensive Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1972","DOI":"10.1007\/s00134-013-3043-4","article-title":"Intensive care unit mortality after cardiac arrest: The relative contribution of shock and brain injury in a large cohort","volume":"39","author":"Lemiale","year":"2013","journal-title":"Intensive Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.jacc.2012.03.036","article-title":"Long-term prognosis following resuscitation from out of hospital cardiac arrest: Role of percutaneous coronary intervention and therapeutic hypothermia","volume":"60","author":"Dumas","year":"2012","journal-title":"J. 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