Author:
Helsloot Dries,Fitzgerald Mark,Lefering Rolf,Verelst Sandra,Missant Carlo,
Abstract
Abstract
Background
To which extent trauma- induced disturbances in ionized calcium (iCa2+) levels have a linear relationship with adverse outcomes remains controversial. The goal of this study was to determine the association between the distribution and accompanying characteristics of transfusion-independent iCa2+ levels versus outcome in a large cohort of major trauma patients upon arrival at the emergency department.
Methods
A retrospective observational analysis of the TraumaRegister DGU® (2015–2019) was performed. Adult major trauma patients with direct admission to a European trauma centre were selected as the study cohort. Mortality at 6 h and 24 h, in-hospital mortality, coagulopathy, and need for transfusion were considered as relevant outcome parameters. The distribution of iCa2+ levels upon arrival at the emergency department was calculated in relation to these outcome parameters. Multivariable logistic regression analysis was performed to determine independent associations.
Results
In the TraumaRegister DGU® 30 183 adult major trauma patients were found eligible for inclusion. iCa2+ disturbances affected 16.4% of patients, with hypocalcemia (< 1.10 mmol/l) being more frequent (13.2%) compared to hypercalcemia (≥ 1.30 mmol/l, 3.2%).
Patients with hypo- and hypercalcemia were both more likely (P < .001) to have severe injury, shock, acidosis, coagulopathy, transfusion requirement, and haemorrhage as cause of death. Moreover, both groups had significant lower survival rates. All these findings were most distinct in hypercalcemic patients. When adjusting for potential confounders, mortality at 6 h was independently associated with iCa2+ < 0.90 mmol/L (OR 2.69, 95% CI 1.67–4.34; P < .001), iCa2+ 1.30–1.39 mmol/L (OR 1.56, 95% CI 1.04–2.32, P = 0.030), and iCa2+ ≥ 1.40 mmol/L (OR 2.87, 95% CI 1.57–5.26; P < .001). Moreover, an independent relationship was determined for iCa2+ 1.00–1.09 mmol/L with mortality at 24 h (OR 1.25, 95% CI 1.05–1.48; P = .0011), and with in-hospital mortality (OR 1.29, 95% CI 1.13–1.47; P < .001). Both hypocalcemia < 1.10 mmol/L and hypercalcemia ≥ 1.30 mmol/L had an independent association with coagulopathy and transfusion.
Conclusions
Transfusion-independent iCa2+ levels in major trauma patients upon arrival at the emergency department have a parabolic relationship with coagulopathy, need for transfusion, and mortality. Further research is needed to confirm whether iCa2+ levels change dynamically and are more a reflection of severity of injury and accompanying physiological derangements, rather than an individual parameter that needs to be corrected as such.
Graphical Abstract
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine
Reference36 articles.
1. Vasudeva M, Mathew JK, Groombridge C, Tee JW, Johnny CS, Maini A, et al. Hypocalcemia in trauma patients: a systematic review. J Trauma Acute Care Surg. 2021;90:396–402.
2. Egi M, Kim I, Nichol A, Stachowski E, French CJ, Hart GK, et al. Ionized calcium concentration and outcome in critical illness. Crit Care Med. 2011;39:314–21.
3. Cherry RA, Bradburn E, Carney DE, Shaffer ML, Gabbay RA, Cooney RN. Do early ionized calcium levels really matter in trauma patients? J Trauma - Inj Infect Crit Care. 2006;61:774–9.
4. Chanthima P, Yuwapattanawong K, Thamjamrassri T, Nathwani R, Stansbury LG, Vavilala MS, et al. Association between ionized calcium concentrations during hemostatic transfusion and calcium treatment with mortality in major trauma. Anesth Analg. 2021;132:1684–91.
5. Barry G. Plasma calcium concentration changes in hemorrhagic shock. Am J Physiol. 1971;220:874–9.
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