# Early Serum Calcium Assessment as a Cost-Effective Tool in Risk Stratification of Acute Pancreatitis

## TL;DR

Low serum calcium levels within 24 hours of admission are linked to severe acute pancreatitis, longer hospital stays, and higher mortality, suggesting it could be a useful and cost-effective early risk indicator.

## Contribution

This study demonstrates that early serum calcium assessment is a simple and effective tool for predicting acute pancreatitis severity and outcomes.

## Key findings

- Lower serum calcium levels were significantly associated with higher CTSI grades, prolonged hospital stay, higher BISAP scores, and mortality.
- Hypocalcemia (<8.5 mg/dL) was observed in 58% of patients and correlated with the need for surgical intervention.
- Early calcium measurement within 24 hours of admission may serve as a cost-effective prognostic tool.

## Abstract

Background

Acute pancreatitis is a common gastrointestinal emergency that ranges from mild, self-limiting inflammation to severe disease with multi-organ dysfunction and high mortality. Traditional prognostic scoring systems such as Bedside Index for Severity in Acute Pancreatitis (BISAP) and CT Severity Index (CTSI) are useful but often complex. Biochemical markers like serum calcium may provide a simple and accessible alternative for early risk stratification.

Objective

To evaluate the role of serum calcium as a prognostic marker in patients with acute pancreatitis by assessing its correlation with BISAP score, CTSI, duration of hospital stay, need for surgical intervention, and clinical outcomes, including mortality.

Methods

This study was conducted over 18 months at a tertiary care center. Fifty adult patients (≥18 years) with newly diagnosed acute pancreatitis were enrolled. Serum calcium levels measured within 24 hours of admission were analyzed in relation to BISAP score, CTSI, hospital stay, and clinical outcomes. Data were analyzed using the chi-square test, independent t-test, and Pearson’s correlation. A p-value <0.05 was considered statistically significant.

Results

The mean age of patients was 37.9 ± 13.05 years, with a male predominance (66%, n = 33). Gallstones (58%, n = 29) were the most common etiology. Hypocalcemia (<8.5 mg/dL) was observed in 58% (n = 29) of patients. The mean duration of hospital stay was 12.64 ± 4.09 days. The overall mortality rate was 18%, with 82% of patients discharged after recovery. Lower calcium levels were significantly associated with higher CTSI grades (p = 0.001), prolonged hospital stay (r = -0.694, p = 0.001), higher BISAP scores (r = -0.684, p = 0.001), and mortality (p = 0.001). Patients requiring surgical intervention also had significantly lower calcium levels (p = 0.005).

Conclusion

Hypocalcemia is strongly correlated with disease severity, adverse outcomes, and prolonged hospitalization in acute pancreatitis. Early serum calcium measurement within 24 hours of admission may serve as a simple, cost-effective prognostic tool for clinical decision-making.