In Reply We would like to thank Dr Chen and colleagues for their interest in our study investigating the association between serum calcium level and the extent of bleeding in patients with acute intracerebral hemorrhage (ICH).
The lack of calcium measurements preceding the ICH prevented us from exploring the possibility that hypocalcemia is a consequence and not a determinant of increased bleeding. Reduced nutritional support, metabolic stress response, or secondary complications may indeed influence calcium homeostasis among critically ill patients.1 However, these possibilities appear unlikely considering that serum calcium level was measured in the hyperacute phase of the disease in our study (the median time from stroke onset to calcium measurement was 4 hours). It would also be of interest to analyze blood pressure values before the onset of ICH. However, the relationship between blood pressure values and the extent of bleeding in ICH is controversial. Two randomized clinical trials including more than 3500 patients with ICH showed that the early reduction of systolic blood pressure values did not significantly decrease the risk of hematoma growth.2,3 Finally, we repeated the multivariable logistic regression analysis for ICH expansion and observed that the association between hypocalcemia and increased risk of hematoma growth remained significant after adjusting for age and sex (odds ratio for ICH expansion: 4.96, 95% CI, 1.24- 19.82, P=.02).
Morotti A, Rosand J, Goldstein JN. Considering Blood Pressure Level in the Association Between Serum Calcium Level and the Size and Expansion in Patients With Intracerebral Hemorrhage—Reply. JAMA Neurol. 2017;74(4):483-484. doi:10.1001/jamaneurol.2016.6011