Background

Severe hypercalcemia (HCM) is a common reason for admission in intensive-care unit (ICU). This case series aims to describe the clinical and biological features, etiologies, treatments, and outcome associated with severe HCM. This study included all patients with a total calcemia above 12 mg/dL (3 mmol/L) admitted in two ICUs from January 2007 to February 2017.

Results

131 patients with HCM were included. HCM was related to hematologic malignancy in 58 (44.3%), solid tumors in 29 (22.1%), endocrinopathies in 16 (12.2%), and other causes in 28 (21.3%) patients. 108 (82.4%) patients fulfilled acute kidney injury (AKI) criteria. Among them, 25 (19%) patients required renal replacement therapy (RRT). 51 (38.9%) patients presented with neurological symptoms, 73 (55.7%) patients had cardiovascular manifestations, and 50 (38.1%) patients had digestive manifestations. The use of bisphosphonates (HR, 0.42; 95% CI, 0.27–0.67; P < 0.001) was the only treatment significantly associated with a decrease of total calcemia below 12 mg/dL (3 mmol/L) at day 5. ICU and Hospital mortality rates were, respectively, 9.9% and 21.3%. Simplified Acute Physiologic Score (SAPS II) (OR, 1.05; 95% CI 1.01–1.1; P = 0.03) and an underlying solid tumor (OR, 13.83; 95% CI 2.24–141.25; P = 0.01) were two independent factors associated with hospital mortality in multivariate analysis.

Conclusions

HCM is associated with high mortality rates, mainly due to underlying malignancies. The course of HCM may be complicated by organ failures which are most of the time reversible with early ICU management. Early ICU admission and prompt HCM management are crucial, especially in patients with an underlying solid tumor presenting with neurological symptoms.

中文翻译：

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重症患者严重高钙血症的流行病学，临床特征和处理

背景

重症高钙血症（HCM）是重症监护病房（ICU）入院的常见原因。本病例系列旨在描述与严重HCM相关的临床和生物学特征，病因，治疗方法和预后。该研究纳入了从2007年1月至2017年2月在两个ICU中入院的总血钙高于12 mg / dL（3 mmol / L）的所有患者。

结果

包括131例HCM患者。HCM与58例（44.3％）的血液系统恶性肿瘤，29例（22.1％）的实体瘤，16例（12.2％）的内分泌病变以及28例（21.3％）的其他原因有关。108名（82.4％）患者符合急性肾损伤（AKI）标准。其中，有25名（19％）患者需要进行肾脏替代治疗（RRT）。出现神经系统症状的患者51例（38.9％），具有心血管表现的患者73例（55.7％），具有消化系统症状的患者50例（38.1％）。使用双膦酸盐（HR，0.42; 95％CI，0.27–0.67; P <0.001）是唯一与第5天总血钙降低低于12 mg / dL（3 mmol / L）显着相关的治疗方法。ICU和医院死亡率分别为9.9％和21.3％。简化的急性生理评分（SAPS II）（OR，1.05； 95％CI 1.01–1.1；P  = 0.03）和潜在的实体瘤（OR，13.83； 95％CI 2.24–141.25；P  = 0.01）是两个独立的相关因素与医院死亡率进行多因素分析。

结论

HCM与高死亡率相关，主要是由于潜在的恶性肿瘤。HCM的病程可能因器官衰竭而变得复杂，而器官衰竭通常在早期ICU管理中是可逆的。尽早进入ICU并及时进行HCM管理至关重要，尤其是对于具有神经症状的基础实体瘤患者。