{"id":27684,"date":"2025-03-29T04:16:00","date_gmt":"2025-03-28T20:16:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=27684"},"modified":"2025-03-29T05:49:50","modified_gmt":"2025-03-28T21:49:50","slug":"jama-netw-open%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e4%b8%b4%e5%ba%8a%e5%ae%9e%e8%b7%b5%e4%b8%ad%e4%bd%bf%e7%94%a8%e7%99%bd%e8%9b%8b%e7%99%bd%e6%a0%a1%e6%ad%a3%e7%9a%84%e8%a1%80%e9%92%99","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=27684","title":{"rendered":"[JAMA Netw Open\u53d1\u8868\u8bba\u6587]\uff1a\u4e34\u5e8a\u5b9e\u8df5\u4e2d\u4f7f\u7528\u767d\u86cb\u767d\u6821\u6b63\u7684\u8840\u9499\u6d4b\u5b9a\u7ed3\u679c"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Diabetes and Endocrinology<\/p>\n\n\n\n

January 21, 2025<\/p>\n\n\n\n

Use of Albumin-Adjusted Calcium Measurements in Clinical Practice<\/h1>\n\n\n\n

No\u00e9mie Desgagn\u00e9s, James A. King, Gregory A. Kline, et al<\/h3>\n\n\n\n

JAMA Netw Open. <\/em>2025;8(1):e2455251. doi:10.1001\/jamanetworkopen.2024.55251<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  How accurate are the calcium adjustment formulas that are used in clinical practice?<\/p>\n\n\n\n

Findings<\/strong>  In this cross-sectional study of 22\u202f658 patients, adjusted calcium levels were modestly correlated with ionized calcium; these generally fared no better than unadjusted total calcium alone and had the tendency to systematically underestimate true hypocalcemia and overestimate true hypercalcemia.<\/p>\n\n\n\n

Meaning<\/strong>  These results suggest that the unadjusted total calcium is the best and most practical alternative to ionized calcium in most clinical settings.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Using albumin-adjusted calcium is commonly recommended for for measuring calcium, but with little empirical evidence to support the practice.<\/p>\n\n\n\n

Objective<\/strong>  To assess the correlation between total calcium measurements (with or without adjustment) vs the ionized calcium level as a reference standard.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This was a population-based cross-sectional study in the province of Alberta, Canada, including adults tested for serum total calcium and ionized calcium simultaneously between January 1, 2013, and October 31, 2019. Statistical analysis was performed from March 2023 to October 2024.<\/p>\n\n\n\n

Main Measures and Outcomes<\/strong>  The correlation between unadjusted and adjusted total calcium measurements (using 10 formulas) and the ionized calcium level was evaluated, along with the potential association with the classification of calcium status.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Among 22\u202f658 patients included, 11\u202f889 (52.5%) were female and 10\u202f769 (47.5%) were male; the median (IQR) age was 60 (47-72) years. The unadjusted total calcium (R<\/em>2<\/sup>\u2009=\u200971.7%; 95% CI, 71.1%-72.2%) had a stronger correlation with ionized calcium than the commonly used simplified Payne formula (ie, total calcium [mmol\/L]\u2009+\u20090.02 [40\u2009\u2212\u2009albumin (g\/L)]) (R<\/em>2<\/sup>\u2009=\u200968.9%; 95% CI, 68.0%-69.6%) and correlated similarly to other formulas (Payne: lowest\u00a0R<\/em>2<\/sup>\u2009=\u200960.3%; 95% CI, 59.3%-61.3%; and James: highest\u00a0R<\/em>2<\/sup>\u2009=\u200976.7%; 95% CI, 76.1%-77.3%). When classifying patients into categories of hypocalcemia, normocalcemia, or hypercalcemia, unadjusted total calcium had the best overall agreement (74.5%) with ionized calcium compared with albumin-adjusted calcium using the original Payne and simplified Payne formulas (agreement 63.0% and 58.7%, respectively). Misclassification using the adjustment formulas was worse in the presence of hypoalbuminemia (albumin level <30 g\/L).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  In this cross-sectional study drawn from a contemporaneous population, there appeared to be heavy reliance on adjustment formulas for calcium in clinical practice with little gain but considerable risk of misclassification of true calcium status, especially in the presence of hypoalbuminemia. These results suggest that unadjusted total calcium was the best and most practical alternative to ionized calcium.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Diabetes and Endocrinology […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27684"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=27684"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27684\/revisions"}],"predecessor-version":[{"id":27984,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27684\/revisions\/27984"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=27684"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=27684"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=27684"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}