Transfusion-Related Hypocalcemia After Trauma
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ORIGINAL SCIENTIFIC REPORT
Transfusion-Related Hypocalcemia After Trauma Saskya Byerly1 • Kenji Inaba2 • Subarna Biswas2 • Eugene Wang2 • Monica D. Wong2 • Ira Shulman2 • Elizabeth Benjamin2 • Lydia Lam2 • Demetrios Demetriades2
Accepted: 17 July 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Hypocalcemia is cited as a complication of massive transfusion. However, this is not well studied as a primary outcome in trauma patients. Our primary outcome was to determine if transfusion of packed red blood cells (pRBC) was an independent predictor of severe hypocalcemia (ionized calcium B 3.6 mg/dL). Methods Retrospective, single-center study (01/2004–12/2014) including all trauma patients C 18 yo presenting to the ED with an ionized calcium (iCa) level drawn. Variables extracted included demographics, interventions, outcomes, and iCa. Regression models identified independent risk factors for severe hypocalcemia (SH). Results Seven thousand four hundred and thirty-one included subjects, 716 (9.8%) developed SH within 48 h of admission. Median age: 39 (Range: 18–102), systolic blood pressure: 131 (IQR: 114–150), median Glasgow Coma Scale (GCS): 15 (IQR: 10–15), Injury Severity Score (ISS): 14 (IQR: 9–24). SH patients were more likely to have depressed GCS (13 vs 15, p \ 0.0001), hypotension (23.2% vs 5.1%, p \ 0.0001) and tachycardia (57.0% vs 41.9%, p \ 0.0001) compared to non-SH patients. They also had higher emergency operative rate (71.8% vs 29%, p \ 0.0001) and higher blood administration prior to minimum iCa [pRBC: (8 vs 0, p \ 0.0001), FFP: (4 vs 0, p \ 0.0001), platelet: (1 vs 0, p \ 0.0001)]. Multivariable analysis revealed penetrating mechanism (AOR: 1.706), increased ISS (AOR: 1.029), and higher pRBC (AOR: 1.343) or FFP administered (AOR: 1.097) were independent predictors of SH. SH was an independent predictor of mortality (AOR: 2.658). Regression analysis identified a significantly higher risk of SH at pRBC ? FFP administration of 4 units (AOR: 18.706, AUC:. 897 (0.884–0.909). Conclusion Transfusion of pRBC is an independent predictor of SH and is associated with increased mortality. The predicted probability of SH increases as pRBC ? FFP administration increases.
This study was presented at the 2016 Annual Meeting of the American College of Surgeons (ACS), Washington, DC, October 16, 2016. & Kenji Inaba [email protected]; [email protected]
Monica D. Wong [email protected]
Saskya Byerly [email protected]; [email protected]
Ira Shulman [email protected]
Subarna Biswas [email protected]
Elizabeth Benjamin [email protected]
Eugene Wang [email protected]
Lydia Lam [email protected]
123
World J Surg
Introduction Symptomatic hypocalcemia occurs with decreased levels of circulating ionized calcium. In general, half of the total circulating calcium is ionized with 40% bound to plasma proteins, primarily albumin, and 10% to anions such as sulfate, citrate, and phosphate [1]. Total calcium is often used as a surrogate for ionized cal
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