Trauma-induced disturbances in ionized calcium levels correlate parabolically with coagulopathy, transfusion, and mortality: a multicentre cohort analysis from the TraumaRegister DGU®
Authors' conclusion
Transfusion-independent iCa2+ levels in major trauma patients upon arrival at the emergency department have a parabolic relationship with coagulopathy, need for transfusion, and mortality.
Study context
- Population
- Adult major trauma patients directly admitted to a European trauma centre, TraumaRegister DGU® (2015–2019)
- Participants
- 30,183 participants
- Exposure
- Ionized calcium levels on ED arrival vs outcome
- Outcome
- Mortality at 6 h and 24 h, in-hospital mortality, coagulopathy and need for transfusion
Methodological detailsmulticentre registry, multivariable logistic regression
- Multicentre registry
- Multivariable logistic regression
Main finding
As reported in the abstract
Mortality at 6 h (adjusted) · 6 h
Odds ratio (95% CI)P value
iCa2+ < 0.90 mmol/L
2.69(1.67–4.34)
P < 0.001iCa2+ 1.30-1.39 mmol/L
1.56(1.04–2.32)
P = 0.030iCa2+ ≥ 1.40 mmol/L
2.87(1.57–5.26)
P < 0.001- Hypo- and hypercalcemia both more likely to have severe injury, shock, acidosis, coagulopathy, transfusion requirement and haemorrhage as cause of death, and lower survival; most distinct in hypercalcemia
- P < 0.001
Observational data: associations, not effects.
Further findings
Mortality at 24 h (adjusted)
| OR (95% CI) | P value | ||
|---|---|---|---|
| iCa2+ 1.00-1.09 mmol/L | 1.25 (1.05–1.48) | P = 0.0011 | |
| 0.512Odds ratio (log scale) |
In-hospital mortality (adjusted)
| OR (95% CI) | P value | ||
|---|---|---|---|
| iCa2+ 1.00-1.09 mmol/L | 1.29 (1.13–1.47) | P < 0.001 | |
| 0.512Odds ratio (log scale) |
Coagulopathy and transfusion
- Both hypocalcemia < 1.10 mmol/L and hypercalcemia ≥ 1.30 mmol/L independently associated with coagulopathy and transfusion
Original publication
Trauma-induced disturbances in ionized calcium levels correlate parabolically with coagulopathy, transfusion, and mortality: a multicentre cohort analysis from the TraumaRegister DGU®. Crit Care. Published 6 July 2023. doi:10.
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