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. 2020 Nov;44(11):3743-3750.
doi: 10.1007/s00268-020-05712-x. Epub 2020 Jul 30.

Transfusion-Related Hypocalcemia After Trauma

Saskya Byerly  1 , Kenji Inaba  2 , Subarna Biswas  3 , Eugene Wang  3 , Monica D Wong  3 , Ira Shulman  3 , Elizabeth Benjamin  3 , Lydia Lam  3 , Demetrios Demetriades  3
Affiliations

Transfusion-Related Hypocalcemia After Trauma

Saskya Byerly et al. World J Surg. 2020 Nov.

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 ≤ 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.

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Conflict of interest statement

We have no conflicts of interest and no sources of funding to disclose. IRB approval was obtained and informed consent was waived in compliance with institutional and national guidelines.

Figures

Fig. 1
Fig. 1
Adjusted for covariates, the probability of developing severe hypocalcemia increases with transfusion of PRBC, FFP, or both. Covariates: ISS, penetrating mechanism, PRBC X Plt. Abbreviations: ISS-Injury Severity Score, PRBC-Packed Red Blood Cells, FFP-Fresh Frozen Plasma, Plt-Platelets. The gray bands are 95% confidence intervals
See this image and copyright information in PMC

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