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Association between serum calcium and hemorrhagic transformation in ischemic stroke: A systematic review and meta-analysis

      Highlights

      • The relationship between serum calcium and hemorrhagic transformation remains controversial.
      • We conducted a meta-analysis to explore the relationship between serum calcium and hemorrhagic transformation.
      • The results of this study may provide a basis for the prevention of hemorrhagic transformation.
      • Serum calcium was related to hemorrhagic transformation and may be one of the risk factors for hemorrhagic transformation.

      Abstract

      Background

      Hemorrhagic transformation (HT) is a common complication of ischemic stroke. A growing number of studies have found that serum calcium levels are lower in HT groups than in control groups. However, the relationship between serum calcium and HT remains controversial. We performed a meta-analysis to assess the relationship between serum calcium levels and HT.

      Methods and results

      Electronic databases were searched for studies on serum calcium and HT from inception to November 6, 2021. Ten studies included in present meta-analysis with a total of 3212 participants. Due to the high heterogeneity (I2 = 81%), we chose the random effects model. The results showed that the serum calcium level in the HT group was significantly lower than that in the control group (pooled mean difference, −0.05; 95% confidence interval (CI), (−0.09, −0.02); P = 0.001). Whether thrombolytic or not the results were applied (pooled mean difference, −0.07; 95% CI, (−0.13, −0.01); P = 0.02 and pooled mean difference, −0.03; 95% CI, (−0.06, −0.01); P = 0.007).

      Conclusions

      Serum calcium was related to HT and may be one of the risk factors for HT.

      Keywords

      Abbreviations:

      AIS (acute ischemic stroke), asICH (asymptomatic intracranial hemorrhage), CBM (Chinese Biomedical Literature Database), CI (confidence interval), CNKI (China National Knowledge Infrastructure), CT (computed tomography), EVT (endovascular treatment), HT (hemorrhagic transformation), IVT (intravenous thrombolysis), MRI (magnetic resonance imaging), NA (not available), NOS (Newcastle Ottawa Scale), PRISMA (Preferred Reporting Items for Systematic Reviews and meta-Analyses)
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