AbstractThongprayoon et al. found in a study of 12,599 non-dialysis adult hospitalized patients that serum calcium (SC) disturbances affected more than half of the patients and were associated with increased in-hospital mortality. Similar impacts of SC disturbances on in-hospital mortality have been observed in patients with acute myocardial infarction and the general hospitalized population.

Thongprayoon等人在一项针对12599名非透析成人住院患者的研究中发现，血钙（SC）紊乱影响了一半以上的患者，并与院内死亡率增加有关。在急性心肌梗死患者和一般住院人群中观察到SC紊乱对院内死亡率的类似影响。

Atrial fibrillation (AF), the most common arrhythmia in the intensive care unit (ICU), affects around 6% of critically ill patients. However, the significance of the relationship between SC levels and in-hospital mortality in these patients remains unclear. This study aimed to explore the correlation between SC levels and in-hospital mortality in ICU patients diagnosed with AF.

心房颤动（AF）是重症监护病房（ICU）中最常见的心律失常，影响约6%的重症患者。然而，这些患者的SC水平与院内死亡率之间关系的重要性仍不清楚。本研究旨在探讨诊断为房颤的ICU患者SC水平与院内死亡率之间的相关性。

Data from the MIMIC-IV database included 11,621 AF patients (average age 75.59 ± 11.74 years; 42.56% male), with an in-hospital mortality rate of 8.90%. A nonlinear relationship between SC levels and in-hospital mortality was observed. Effect sizes on either side of the inflection point were 0.79 (HR: 0.79, 95% CI 0.67–0.94, P = 0.006) and 1.12 (HR: 1.12, 95% CI 1.01–1.25, P = 0.029).

来自MIMIC-IV数据库的数据包括11621名AF患者（平均年龄75.59±11.74岁；42.56%男性），院内死亡率为8.90%。观察到SC水平与院内死亡率之间存在非线性关系。拐点两侧的效应大小分别为0.79（HR:0.79，95%CI 0.67-0.94，P=0.006）和1.12（HR:1.12，95%CI 1.01-1.25，P=0.029）。

Sensitivity analyses confirmed these results. SC levels around 8.56 mg/dL were associated with the lowest risk of in-hospital mortality, with risks increasing as SC levels deviated from this point. SC levels below this inflection point were linked to more pronounced clinical impacts. This finding has significant clinical implications for clinicians.

。SC水平约为8.56 mg/dL与院内死亡风险最低有关，随着SC水平偏离这一点，风险增加。低于这个拐点的SC水平与更明显的临床影响有关。这一发现对临床医生具有重要的临床意义。

Therefore, in the treatment of ICU patients with AF, clinicians should closely monitor SC levels, with a focus on maintaining them around 8.56 mg/dL..

因此，在治疗ICU房颤患者时，临床医生应密切监测SC水平，重点是将其维持在8.56 mg/dL左右。。

IntroductionCalcium, one of the most abundant minerals in the human body, plays essential roles in muscle function, nerve transmission, intracellular signaling, and vascular constriction and dilation regulation1. Additionally, intracellular calcium concentration changes are crucial in regulating cardiac contractility2.

引言钙是人体内最丰富的矿物质之一，在肌肉功能，神经传递，细胞内信号传导以及血管收缩和扩张调节中起着至关重要的作用1。此外，细胞内钙浓度的变化对调节心脏收缩力至关重要2。

As a result, calcium levels are stringently controlled both cellularly and systemically, with variations affecting numerous physiological functions across various organs3,4,5.In clinical settings, abnormalities in blood calcium and serum calcium (SC) fluctuations are notably prevalent among critically ill patients.

因此，钙水平在细胞和系统上都受到严格控制，其变化影响各种器官的许多生理功能3,4,5。在临床环境中，血钙和血钙（SC）波动异常在危重患者中尤为普遍。

These are influenced by several key factors, including magnesium levels, vitamin D, and parathyroid hormone (PTH)6,7,8,9. Both elevated and reduced SC levels are associated with adverse clinical outcomes, such as increased mortality, among hospitalized patients10,11,12,13,14. Notably, even after adjustments for age, sex, cardiovascular risk factors, echocardiographic parameters, and laboratory markers, low SC levels are linked to an elevated risk of postoperative Atrial fibrillation (AF) in patients undergoing isolated coronary artery bypass graft surgery, highlighting its significance in patients with AF15.AF is the most common arrhythmia in the intensive care unit (ICU), affecting approximately 6% of critically ill patients16.

这些受几个关键因素的影响，包括镁水平，维生素D和甲状旁腺激素（PTH）6,7,8,9。在住院患者中，SC水平升高和降低均与不良临床结果相关，例如死亡率增加10,11,12,13,14。值得注意的是，即使在调整了年龄，性别，心血管危险因素，超声心动图参数和实验室指标后，低SC水平也与接受孤立性冠状动脉旁路移植术的患者术后心房颤动（AF）的风险升高有关，突出了其在AF15患者中的重要性.AF是重症监护病房（ICU）中最常见的心律失常，影响约6%的危重患者16。

It is particularly prevalent among those with specific conditions such as severe sepsis17. Not all patients with AF benefit from ICU admission, making it essential to consider the in-hospital mortality rate following ICU admission.In a study by Thongprayoon, C. et al., involving 12,599 non-dialysis adult inpatients, it was found that serum ionized calcium disturbances affected over half of the patients and were associat.

在患有严重脓毒症等特定疾病的患者中尤其普遍17。并非所有房颤患者都能从入住ICU中受益，因此有必要考虑入住ICU后的院内死亡率。在Thongprayoon，C.等人的一项涉及12599名非透析成人住院患者的研究中，发现血清离子钙紊乱影响了一半以上的患者，并且是相关的。

Data availability

数据可用性

The data in the article can be obtained from the mimic-IV database (https://mimic.physionet.org/).

本文中的数据可以从mimic IV数据库中获得(https://mimic.physionet.org/)。

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Download referencesAcknowledgementsWe thank Dr. Bin Liang and the arrhythmia team of the Second Hospital of Shanxi Medical University for helping in this revision.FundingFunding for this project was provided by the National Natural Science Foundation of China [Grant No. 81970391].Author informationAuthors and AffiliationsDepartment of Cardiology, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, ChinaXin Zheng, Leigang Wang, Hongxuan Fan, Bing Yu, Xiaogang Qi & Bin LiangDepartment of Cardiology, Yangquan First People’s Hospital, Yangquan, Shanxi, ChinaFenfang ZhangOrthopedics Department, Yangquan First People’s Hospital, Yangquan, Shanxi, ChinaXiaogang QiAuthorsXin ZhengView author publicationsYou can also search for this author in.

下载参考文献致谢我们感谢梁斌博士和山西医科大学第二医院心律失常团队在此次修订中的帮助。资助该项目的资金由国家自然科学基金（批准号81970391）提供。作者信息作者和所属单位山西医科大学第二医院心内科，山西太原，中国郑昕，王雷刚，范红萱，俞冰，齐小刚和梁斌，山西阳泉市阳泉市第一人民医院心内科，中国山西阳泉市阳泉市第一人民医院张芬芳骨科，中国山西阳泉市小刚乔作者辛正观点作者出版物您也可以在中搜索这位作者。

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PubMed Google ScholarContributionsX. Z. and B. L. contributed to the conception and design of the study. X. Z., F. Z., L. W., and H. F. performed the statistical analysis and wrote the manuscript. B. L. for revision and final approval. There is no doubt that all of the listed authors have made a great, intellectual, and substantial contribution to the work, as well as given their approval for publication.Corresponding authorCorrespondence to.

PubMed谷歌学术贡献x。Z、 B.L.为研究的概念和设计做出了贡献。十、 Z.，F.Z.，L.W。和H.F.进行了统计分析并撰写了手稿。B、 L.用于修订和最终批准。毫无疑问，所有列出的作者都对这项工作做出了巨大的，智力的和实质性的贡献，并批准了他们的出版。对应作者对应。

Bin Liang.Ethics declarations

梁斌。道德宣言

Ethics approval and consent to participate

道德批准和同意参与

The establishment of this database was approved by the Massachusetts Institute of Technology (Cambridge, MA) and Beth Israel Deaconess Medical Center (Boston, MA), and consent was obtained for the original data collection. Therefore, the ethical approval statement and the need for informed consent were waived for this manuscript..

该数据库的建立得到了麻省理工学院（马萨诸塞州剑桥）和贝斯以色列女执事医疗中心（马萨诸塞州波士顿）的批准，并获得了原始数据收集的同意。因此，本手稿放弃了道德批准声明和知情同意的需要。。

Consent for publication

同意出版

There was no requirement of individual informed consent to extract data from the mimic-IV database because mimic-IV database information was publicly available and all patient data were deidentified.

不需要个人知情同意才能从mimic IV数据库中提取数据，因为mimic IV数据库信息是公开的，并且所有患者数据都被识别。

Competing interests

相互竞争的利益

The authors declare no competing interests.

。

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Reprints and permissionsAbout this articleCite this articleZheng, X., Zhang, F., Wang, L. et al. Association between serum calcium and in-hospital mortality in critically ill atrial fibrillation patients from the MIMIC IV database.

转载和许可本文引用本文Zheng，X.，Zhang，F.，Wang，L。等人。MIMIC IV数据库中重症心房颤动患者血清钙与住院死亡率之间的关系。

Sci Rep 14, 27954 (2024). https://doi.org/10.1038/s41598-024-79015-9Download citationReceived: 11 June 2024Accepted: 05 November 2024Published: 14 November 2024DOI: https://doi.org/10.1038/s41598-024-79015-9Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

科学报告1427954（2024）。https://doi.org/10.1038/s41598-024-79015-9Download引文接收日期：2024年6月11日接受日期：2024年11月5日发布日期：2024年11月14日OI：https://doi.org/10.1038/s41598-024-79015-9Share本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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KeywordsAtrial fibrillationSerum calciumIn-hospital mortalityIntensive care unitNonlinearMIMIC-IV database

关键词心房纤颤血清钙在医院死亡率重症监护室非线性体温IV数据库