Early Hypocalcemia in Severe Trauma: An Independent Risk Factor for Coagulopathy and Massive Transfusion
Abstract
:1. Introduction
2. Materials and Methods
2.1. Setting
2.2. Data
2.3. Sample
2.4. Definitions
2.5. Statistical Analysis
2.6. Endpoints
2.7. Statistical Analysis
3. Results
4. Discussion
4.1. Crystalloids and Colloids Infusions
4.2. Alcohol Intake
4.3. Crush Injuries
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Normocalcemia n = 669 | Hypocalcemia n = 129 | Total n = 798 | |
---|---|---|---|
Characteristics | |||
Age, yrs, mean +/− SD | 47 ± 20 | 46 ± 20 | 47 ± 20 |
Male, n (%) | 502 (75) | 91 (71) | 593 (74) |
Female, n (%) | 167 (25) | 37 (29) | 204 (26) |
Blunt trauma, n (%) | 669 (100) | 128 (100) | 797 (100) |
Penetrating trauma, n (%) | 0 (0) | 0 (0) | 0 (0) |
Crush trauma, n (%) | 8 (1) | 0 (0) * | 8 (1) |
Isolated Head or Spine trauma, n (%) | 152 (23) | 22 (17) | 174 (22) |
Alcohol intake, n (%) | 62 (15) n = 409 | 22 (27) ** n= 80 | 87 (18) n = 489 |
Anticoagulant/ antiplatelet use, n(%) | 13 (2) n = 625 | 1 (1) n = 120 | 14 (2) n = 745 |
ISS, median (95% CI) | 26 (20–33) | 38 (28–50) * | 26 (21–36) |
Prehospital phase | |||
SAP, mmHg, mean ± SD | 127 ± 29 n = 661 | 105 ± 36 * n = 122 | 123 ± 31 n = 783 |
HR, beats/min, mean ± SD | 92 ± 25 n = 665 | 100 ± 29 * n = 127 | 93 ± 26 n = 792 |
SI, mean ± SD | 0.8 ± 0.3 n = 661 | 1.1 ± 0.6 * n = 122 | 0.8 ± 0.4 n = 783 |
Glasgow Coma Scale, median (95%CI) | 15 (12–15) n = 664 | 13 (6–15) * | 15 (11–15) n = 792 |
Cristalloids, mL, mean ± SD | 710 ± 456 n = 204 | 985 ± 509 * n = 56 | 578 ± 450 |
Colloids, mL, mean ± SD | 7 ± 66 n = 662 | 47 ± 156 * n = 126 | 13 ± 88 n = 788 |
Trauma center admission | |||
Hospital SAP, mmHg, mean ± SD | 133 ± 28 n = 668 | 114 ± 29 * n = 124 | 130 ± 29 n = 792 |
Hospital HR, beats/min, mean ± SD | 90 ± 23 | 103 ± 26 * n = 125 | 92 ± 24 |
Prehospital time, mins, mean ± SD | 71 ± 23 n = 129 | 77 ± 24 n = 21 | 72 ± 23 n = 150 |
Outcome | |||
Massive tansfusion, n (%) | 22 (3.3) | 33 (25.8) * | 55 (6.9) |
Multiple transfusions, n (%) | 83 (12.4) | 66 (51.6) * | 149 (18.7) |
pRBC, units, mean ± SD | 1.5 ± 3.3 | 7.5 ± 9.2* | 2.5 ± 5.4 |
Observed death, n (%) | 18 (2.7) n = 659 | 16 (12.9) * n = 124 | 34 (4.3) n = 783 |
Normocalcemia n = 669 | Hypocalcemia n = 129 | |
---|---|---|
Ionized calcium, mmol/L, mean ± SD | 1.17 ± 0.05 n = 667 | 1.03 ± 0.09 * |
Prothrombin time INR, mean ± SD | 1.12 ± 0.21 n = 576 | 1.41 ± 0.4 * n = 103 |
aPTT ratio, mean ± SD | 0.88 ± 0.22 n = 573 | 1.20 ± 0.63 * n = 102 |
Base Excess, mmol/L, mean ± SD | −3.5 ± 3.9 n = 621 | −8.6 ± 9.8 * n = 125 |
Lactates, mmol/L, mean ± SD | 2.6 ± 1.6 n = 663 | 4.3 ± 3.3 * n = 127 |
OR (95% CI) | p-Value | |
---|---|---|
ISS | 1.07 (1.04–1.10) | <0.0001 |
Lactates, mmol/L | 1.29 (1.13–1.48) | <0.001 |
Cristalloids, mL | 1.00 (1.00–1.00) | 0.003 |
Hypocalcemia (Ionized calcium < 1.1 mmol/L) | 2.42 (1.13–5.16) | 0.02 |
OR (95% CI) | p-Value | |
---|---|---|
Alcohol intake | 2.32 (1.13–4.74) | 0.02 |
INR > 1.5 | 9.47 (2.89–31.0) | 0.0002 |
Cristalloids, mL | 1.00 (1.00–1.00) | 0.01 |
ISS | 1.03 (1.00–1.06) | 0.03 |
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Vettorello, M.; Altomare, M.; Spota, A.; Cioffi, S.P.B.; Rossmann, M.; Mingoli, A.; Chiara, O.; Cimbanassi, S. Early Hypocalcemia in Severe Trauma: An Independent Risk Factor for Coagulopathy and Massive Transfusion. J. Pers. Med. 2023, 13, 63. https://doi.org/10.3390/jpm13010063
Vettorello M, Altomare M, Spota A, Cioffi SPB, Rossmann M, Mingoli A, Chiara O, Cimbanassi S. Early Hypocalcemia in Severe Trauma: An Independent Risk Factor for Coagulopathy and Massive Transfusion. Journal of Personalized Medicine. 2023; 13(1):63. https://doi.org/10.3390/jpm13010063
Chicago/Turabian StyleVettorello, Marco, Michele Altomare, Andrea Spota, Stefano Piero Bernardo Cioffi, Marta Rossmann, Andrea Mingoli, Osvaldo Chiara, and Stefania Cimbanassi. 2023. "Early Hypocalcemia in Severe Trauma: An Independent Risk Factor for Coagulopathy and Massive Transfusion" Journal of Personalized Medicine 13, no. 1: 63. https://doi.org/10.3390/jpm13010063