Hypercalcaemia: patients with calcium levels > 3.50 mmol/l were at increased risk of malignancy

Clinical bottom line (level 4)

  1. Malignancy was the commonest cause of hypercalcaemia in hospital in-patients.
  2. Patients with a calcium level > 3.50 mmol/l were at increased risk of having malignancy (LR + 5.7) .
Fisken et al: Quarterly Journal of Medicine 1980; 196 : 405-418
Expires January 2004

The study

Setting: university hospital, UK 1976-78

469 patients (aged ?, ?% male) with serum calcium > 2.70 mmol/l (> 2.50 mmol/l if albumin< 20 g/l)

Excluded if
  • referred from other institutions
  • calcium due to high albumin level
  • single high calcium measure
  • records unavailable


    ?independent unblinded reference standard, applied in all patients from a ?consecutive ?appropriate spectrum.
    Reference standard:
    • final diagnosis confirmed through hospital records or contacting GP
    Diagnostic test: serum calcium

    The evidence


    differential diagnosis number of patients prevalence
    (95% CI)
    malignancy 219 47%
    (42% to 51%)
    no cause found 102 22%
    (18% to 26%)
    on renal dialysis 68 15%
    (11% to 18%)
    primary hyperparathyroidism 59 13%
    (9.6% to 16%)
    excessive vitamin D therapy 10 2.1%
    (0.8% to 3.4%)
    other causes 6 469%
    (0.3% to 2.3%)
    thyrotoxicosis 4 0.9%
    (0.0% to 1.7%)
    sarcoidosis 1 0.2%
    (0.0% to 0.6%)


    diagnostic test malignancy no malignancy LR
    (95% CI)    		 post-test probability
    calcium 3.50 mmol/l or higher 30 6 5.7
    (2.9 to 11)     		82%
    3.00 to 3.49 mmol/l 66 49 1.7
    (1.2 to 2.5)     		57%
    < 3.00 mmol/l 108 218 0.63
    (0.54 to 0.73)     		33%
    total 219 277


    diagnostic test primary hyperparathyroidism no primary hyperparathyroidism LR
    (95% CI)    		 post-test probability
    calcium 3.00 mmol/l or higher 34 136 1.9
    (1.4 to 2.4)     		20%
    total 59 437

    Comments

    1. 58% of those with malignancy survived less than three months.

    Citation

    1. Fisken RA, Heath DA, Bold AM: hypercalcaemia - a hospital survey. Quarterly Journal of Medicine 1980; 196 : 405-418
    Search Terms: ?
    Contributor: Clare Wotton, Musab Hayatli, October 2001
    Reviewer: Chris Ball

    Clinical Question.
    Patient hypercalcaemia
    Intervention or Exposure serum calcium
    Outcome final diagnosis, malignancy, hyperparathyroidism