Retrospective analysis of the effects of hypocalcemia in severely injured trauma patients.

Autor: Ciaraglia A; UT Health Science Center San Antonio, Department of Surgery, United States. Electronic address: ciaraglia@uthscsa.edu., Lumbard D; UT Health Science Center San Antonio, Department of Surgery, United States., DeLeon M; UT Health Science Center San Antonio, Department of Surgery, United States., Barry L; UT Health Science Center San Antonio, Department of Surgery, United States., Braverman M; UT Health Science Center San Antonio, Department of Surgery, United States., Schauer S; San Antonio Military Medical Center, Department of Emergency Medicine, United States., Eastridge B; UT Health Science Center San Antonio, Department of Surgery, United States., Stewart R; UT Health Science Center San Antonio, Department of Surgery, United States., Jenkins D; UT Health Science Center San Antonio, Department of Surgery, United States., Nicholson S; UT Health Science Center San Antonio, Department of Surgery, United States.
Jazyk: angličtina
Zdroj: Injury [Injury] 2024 May; Vol. 55 (5), pp. 111386. Date of Electronic Publication: 2024 Feb 01.
DOI: 10.1016/j.injury.2024.111386
Abstrakt: Background: It has been suggested that the Lethal Triad be modified to include hypocalcemia, coined as the Lethal Diamond. Hypocalcemia in trauma has been attributed to multiple mechanisms, but new evidence suggests that traumatic injury may result in the development of hypoCa independent of blood transfusion. We hypothesize that hypocalcemia is associated with increased blood product requirements and mortality.
Methods: A retrospective study of 1,981 severely injured adult trauma patients from 2016 to 2019. Ionized calcium (iCa) levels were obtained on arrival and subjects were categorized by a threshold iCa level of 1.00 mmol/L and compared. Univariable and multivariable logistic regression analysis was performed.
Results: The hypocalcemia (iCa <1.00 mmol/L) group had increased rate of overall (p = 0.001), 4-hr (p = 0.007), and 24-hr (p = 0.003) mortality. There was no difference in prehospital transfusion volume between groups (p = 0.25). Hypocalcemia was associated with increased blood product requirements at 4 h (p <0.001), 24 h (p <0.001), and overall hospital length of stay (p <0.001). Logistic regression analysis showed increased odds of 4-hour mortality (OR 0.077 [95 % CI 0.011, 0.523], p = 0.009) and 24-hour mortality (OR 0.121 [95 % CI 0.019, 0.758], p = 0.024) for every mmol/L increase in iCa.
Conclusions: This study shows the association of hypoCa and traumatic injury. Severe hypoCa was associated with increased odds of early and overall mortality and increased blood product requirements. These results support the need for future prospective trials assessing the role of hypocalcemia in trauma.
Competing Interests: Declaration of competing interest The views represented in this presentation do not represent the views of the Department of Defense, United States Government, or any branches of the United States Military, No relevant financial relationships to disclose. The authors have no relevant conflicts of interest. Data access from institutional database and electronic medical records. Data can be accessed upon request.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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