Association between admission serum calcium and clinical outcomes in patients with large ischemic stroke after endovascular treatment

This study aimed to examine the association between admission total serum calcium (Ca) levels and clinical outcomes in patients with large ischemic stroke following endovascular treatment (EVT). This study is a subgroup analysis of a prospective cohort, including 359 patients who underwent EVT and had total serum calcium levels measured at admission. Patients were stratified into three groups based on their admission total serum calcium levels, categorized according to tertiles. The primary outcome was modified Rankin Scale (mRS) score 0–3 at 90 days. Safety outcomes included 90-day mortality and symptomatic intracranial hemorrhage (sICH) within 48 h. The 359 included patients were stratified according to tertiles of admission total serum calcium levels: Tertile 1 ( ≤ 2.15 mmol/L), Tertile 2 (2.16–2.28 mmol/L), and Tertile 3 ( > 2.28 mmol/L). Compared with patients in Tertile 1, those in Tertile 2 had significantly higher odds of achieving mRS 0–3 (adjusted odds ratio [aOR] 3.14, 95% CI 1.59–6.17, P = 0.001), and patients in Tertile 3 also demonstrated significantly increased odds of mRS 0–3 (aOR 2.57, 95% CI 1.31–5.03, P = 0.006). In addition, both higher tertiles were associated with significantly lower mortality compared with Tertile 1. There were no significant differences in the incidence of sICH among the three groups. In patients with large ischemic stroke undergoing EVT, an elevated admission serum calcium level was associated with a higher likelihood of mRS 0–3 and lower mortality. These findings suggest that blood calcium levels may serve as a potential prognostic biomarker for this population.