Cargando…

Transfusion-Related Hypocalcemia After Trauma

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 cal...

Descripción completa

Detalles Bibliográficos
Autores principales: Byerly, Saskya, Inaba, Kenji, Biswas, Subarna, Wang, Eugene, Wong, Monica D., Shulman, Ira, Benjamin, Elizabeth, Lam, Lydia, Demetriades, Demetrios
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391918/
https://www.ncbi.nlm.nih.gov/pubmed/32734451
http://dx.doi.org/10.1007/s00268-020-05712-x
_version_ 1783564745925722112
author Byerly, Saskya
Inaba, Kenji
Biswas, Subarna
Wang, Eugene
Wong, Monica D.
Shulman, Ira
Benjamin, Elizabeth
Lam, Lydia
Demetriades, Demetrios
author_facet Byerly, Saskya
Inaba, Kenji
Biswas, Subarna
Wang, Eugene
Wong, Monica D.
Shulman, Ira
Benjamin, Elizabeth
Lam, Lydia
Demetriades, Demetrios
author_sort Byerly, Saskya
collection PubMed
description 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 ≤ 3.6 mg/dL). METHODS: Retrospective, single-center study (01/2004–12/2014) including all trauma patients ≥ 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.
format Online
Article
Text
id pubmed-7391918
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Springer International Publishing
record_format MEDLINE/PubMed
spelling pubmed-73919182020-07-31 Transfusion-Related Hypocalcemia After Trauma Byerly, Saskya Inaba, Kenji Biswas, Subarna Wang, Eugene Wong, Monica D. Shulman, Ira Benjamin, Elizabeth Lam, Lydia Demetriades, Demetrios World J Surg Original Scientific Report 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 ≤ 3.6 mg/dL). METHODS: Retrospective, single-center study (01/2004–12/2014) including all trauma patients ≥ 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. Springer International Publishing 2020-07-30 2020 /pmc/articles/PMC7391918/ /pubmed/32734451 http://dx.doi.org/10.1007/s00268-020-05712-x Text en © Société Internationale de Chirurgie 2020 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original Scientific Report
Byerly, Saskya
Inaba, Kenji
Biswas, Subarna
Wang, Eugene
Wong, Monica D.
Shulman, Ira
Benjamin, Elizabeth
Lam, Lydia
Demetriades, Demetrios
Transfusion-Related Hypocalcemia After Trauma
title Transfusion-Related Hypocalcemia After Trauma
title_full Transfusion-Related Hypocalcemia After Trauma
title_fullStr Transfusion-Related Hypocalcemia After Trauma
title_full_unstemmed Transfusion-Related Hypocalcemia After Trauma
title_short Transfusion-Related Hypocalcemia After Trauma
title_sort transfusion-related hypocalcemia after trauma
topic Original Scientific Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391918/
https://www.ncbi.nlm.nih.gov/pubmed/32734451
http://dx.doi.org/10.1007/s00268-020-05712-x
work_keys_str_mv AT byerlysaskya transfusionrelatedhypocalcemiaaftertrauma
AT inabakenji transfusionrelatedhypocalcemiaaftertrauma
AT biswassubarna transfusionrelatedhypocalcemiaaftertrauma
AT wangeugene transfusionrelatedhypocalcemiaaftertrauma
AT wongmonicad transfusionrelatedhypocalcemiaaftertrauma
AT shulmanira transfusionrelatedhypocalcemiaaftertrauma
AT benjaminelizabeth transfusionrelatedhypocalcemiaaftertrauma
AT lamlydia transfusionrelatedhypocalcemiaaftertrauma
AT demetriadesdemetrios transfusionrelatedhypocalcemiaaftertrauma