SERUM LEVELS OF PARATHYROID-HORMONE ARE RELATED TO THE MORTALITY AND SEVERITY OF ILLNESS IN PATIENTS IN THE EMERGENCY DEPARTMENT

Hypocalcaemia is a common finding in intensive care patients. in addit ion, raised levels of parathyroid hormone (PTH) have been described. T he explanation and clinical importance of these findings are yet to be revealed. To investigate the occurrence of hypocalcaemia and elevated PTH levels and their relationship to morality and the severity of dis ease, serum levels of PTH, ionized calcium (Ca2+) and the cytokines in terleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-alpha) were m easured on arrival in the emergency department in a broad spectrum of 140 acutely ill patients patients suffering from common diseases such as stroke, acute abdominal disorders, obstructive lung diseases, heart failure, acute myocardial infarction, angina pectoris, trauma and inf ectious diseases. A score (APACHE LI) was calculated to assess the sev erity of disease. Elevated PTH levels (> 55 pg mL(-1)) were seen in 16 % of the patients, being most frequent in patients with myocardial inf arction (28%) and congestive heart failure (42%). The levels were sign ificantly correlated with the APACHE Di score (r = 0.48, P<0.0001) and with the length of stay in hospital (r = 0.26, P<0.002). PTH was also significantly (P<0.03) elevated in non-survivors compared with surviv ors and was found to be a stronger predictor of mortality (P<0.01) tha n the APACHE II score (P<0.02) in Cox's proportional hazard analysis. No close relationships were found between the cytokine levels and the indices of calcium metabolism. In conclusion, a rise in serum levels o f PTH was common and related to the severity of disease and mortality in a mixed emergency department population.