Background Hypocalcemia and increased serum levels of calcitonin precursors
are common in critically HI patients, especially in those with sepsis. We
investigated calcium homeostasis in such patients.
Patients and methods Serum concentrations of total and ionized calcium and
known factors influencing or reflecting calcium homeostasis were measured i
n 101 consecutive patients of a medical intensive care unit. Calcitonin pre
cursor levels were determined using a highly sensitive radioimmunoassay.
Results Critical illness per se was associated with decreased serum total a
nd ionized calcium levels, which correlated with the severity of the underl
ying disease as measured by the APACHE II score. In addition, total and ion
ized hypocalcemia was more pronounced with increasing severity of infection
(P < 0.02), and occurred in parallel with a marked increase of calcitonin
precursors (P < 0.001). Mature calcitonin levels, however, remained normal.
Changes of serum ionized calcium concentrations from admission to discharg
e correlated significantly with changes in the serum calcitonin precursor c
oncentration (r(2) = -0.14, P < 0.001). Circulating vitamin D levels, parat
hyroid hormone levels and other markers reflecting calcium homeostasis did
not correlate with the severity of infection.
Conclusions In critically ill patients with sepsis, markedly elevated circu
lating calcitonin precursors might play a role in the development of the pr
onounced hypocalcemia. The specific calcitonin precursor(s) responsible for
this effect and the pathophysiological mechanism remain to be elucidated.