Calcium supplementation during trauma resuscitation: a propensity score-matched analysis from the TraumaRegister DGU
Calcium
Hypocalcemia
Mortality
Trauma resuscitation
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
05 Jul 2024
05 Jul 2024
Historique:
received:
12
04
2024
accepted:
24
06
2024
medline:
6
7
2024
pubmed:
6
7
2024
entrez:
5
7
2024
Statut:
epublish
Résumé
In major trauma patients, hypocalcemia is associated with increased mortality. Despite the absence of strong evidence on causality, early calcium supplementation has been recommended. This study investigates whether calcium supplementation during trauma resuscitation provides a survival benefit. We conducted a retrospective analysis using data from the TraumaRegister DGU Within a cohort of 28,323 directly admitted adult major trauma patients at a European trauma center, 1593 (5.6%) received calcium supplementation. Using multivariable logistic regression to generate propensity scores, two comparable groups of 1447 patients could be matched. No significant difference in early mortality (6 h and 24 h) was observed, while in-hospital mortality appeared higher in those with calcium supplementation (28.3% vs. 24.5%, P = 0.020), although this was not significant when adjusted for predicted mortality (P = 0.244). In this matched cohort, no evidence was found for or against a survival benefit from calcium supplementation during trauma resuscitation. Further research should focus on understanding the dynamics and kinetics of ionized calcium levels in major trauma patients and identify if specific conditions or subgroups could benefit from calcium supplementation.
Sections du résumé
BACKGROUND
BACKGROUND
In major trauma patients, hypocalcemia is associated with increased mortality. Despite the absence of strong evidence on causality, early calcium supplementation has been recommended. This study investigates whether calcium supplementation during trauma resuscitation provides a survival benefit.
METHODS
METHODS
We conducted a retrospective analysis using data from the TraumaRegister DGU
RESULTS
RESULTS
Within a cohort of 28,323 directly admitted adult major trauma patients at a European trauma center, 1593 (5.6%) received calcium supplementation. Using multivariable logistic regression to generate propensity scores, two comparable groups of 1447 patients could be matched. No significant difference in early mortality (6 h and 24 h) was observed, while in-hospital mortality appeared higher in those with calcium supplementation (28.3% vs. 24.5%, P = 0.020), although this was not significant when adjusted for predicted mortality (P = 0.244).
CONCLUSION
CONCLUSIONS
In this matched cohort, no evidence was found for or against a survival benefit from calcium supplementation during trauma resuscitation. Further research should focus on understanding the dynamics and kinetics of ionized calcium levels in major trauma patients and identify if specific conditions or subgroups could benefit from calcium supplementation.
Identifiants
pubmed: 38970063
doi: 10.1186/s13054-024-05002-1
pii: 10.1186/s13054-024-05002-1
doi:
Substances chimiques
Calcium
SY7Q814VUP
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
222Informations de copyright
© 2024. The Author(s).
Références
Wray JP, Bridwell RE, Schauer SG, Shackelford SA, Bebarta VS, Wright FL, et al. The diamond of death: hypocalcemia in trauma and resuscitation. Am J Emerg Med. 2021;41:104–9.
pubmed: 33421674
doi: 10.1016/j.ajem.2020.12.065
Helsloot D, Fitzgerald M, Lefering R, Verelst S, Missant C. Trauma-induced disturbances in ionized calcium levels correlate parabolically with coagulopathy, transfusion, and mortality: a multicentre cohort analysis from the TraumaRegister DGU
doi: 10.1186/s13054-023-04541-3
Byerly S, Inaba K, Biswas S, Wang E, Wong MD, Shulman I, et al. Transfusion-related hypocalcemia after trauma. World J Surg. 2020;44:3743–50.
pubmed: 32734451
pmcid: 7391918
doi: 10.1007/s00268-020-05712-x
Giancarelli A, Birrer KL, Alban RF, Hobbs BP, Liu-Deryke X. Hypocalcemia in trauma patients receiving massive transfusion. J Surg Res. 2016;202:182–7.
pubmed: 27083965
doi: 10.1016/j.jss.2015.12.036
Webster S, Todd S, Redhead J, Wright C. Ionised calcium levels in major trauma patients who received blood in the emergency department. Emerg Med J. 2016;33:569–72.
pubmed: 26848163
doi: 10.1136/emermed-2015-205096
Vivien B, Langeron O, Morell E, Devilliers C, Carli PA, Coriat P, et al. Early hypocalcemia in severe trauma. Crit Care Med. 2005;33:1946–52.
pubmed: 16148464
doi: 10.1097/01.CCM.0000171840.01892.36
Ho KM, Yip CB. Concentration-dependent effect of hypocalcaemia on in vitro clot strength in patients at risk of bleeding: a retrospective cohort study. Transfus Med. 2016;26:57–62.
pubmed: 26729371
doi: 10.1111/tme.12272
Matthay ZA, Kornblith LZ. Platelet contributions to trauma-induced coagulopathy: updates in post-injury platelet biology, platelet transfusions, and emerging platelet-based hemostatic agents. Curr Trauma Rep. 2019;5:202–9.
doi: 10.1007/s40719-019-00176-4
Vasudeva M, Mathew JK, Groombridge C, Tee JW, Johnny CS, Maini A, et al. Hypocalcemia in trauma patients: a systematic review. J Trauma Acute Care Surg. 2021;90:396–402.
pubmed: 33196630
doi: 10.1097/TA.0000000000003027
Kronstedt S, Roberts N, Ditzel R, Elder J, Steen A, Thompson K, et al. Hypocalcemia as a predictor of mortality and transfusion: a scoping review of hypocalcemia in trauma and hemostatic resuscitation. Transfusion. 2022;62:S158–66.
pubmed: 35748676
pmcid: 9545337
doi: 10.1111/trf.16965
Ditzel RM, Anderson JL, Eisenhart WJ, Rankin CJ, DeFeo DR, Oak S, et al. A review of transfusion- and trauma-induced hypocalcemia: is it time to change the lethal triad to the lethal diamond? J Trauma Acute Care Surg. 2020;88:434–9.
pubmed: 31876689
doi: 10.1097/TA.0000000000002570
Mackay EJ, Stubna MD, Holena DN, Reilly PM, Seamon MJ, Smith BP, et al. Abnormal calcium levels during trauma resuscitation are associated with increased mortality, increased blood product use, and greater hospital resource consumption: a pilot investigation. Anesth Analg. 2017;125:895–901.
pubmed: 28704250
pmcid: 5918410
doi: 10.1213/ANE.0000000000002312
Hall C, Nagengast AK, Knapp C, Behrens B, Dewey EN, Goodman A, et al. Massive transfusions and severe hypocalcemia: an opportunity for monitoring and supplementation guidelines. Transfusion. 2021;61:S188–94.
pubmed: 34269436
doi: 10.1111/trf.16496
Rossaint R, Afshari A, Bouillon B, Cerny V, Cimpoesu D, Curry N, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care. 2023;27:1–45.
doi: 10.1186/s13054-023-04327-7
DeBot M, Sauaia A, Schaid T, Moore EE. Trauma-induced hypocalcemia. Transfusion. 2022;62:S274–80.
pubmed: 35748689
doi: 10.1111/trf.16959
Imamoto T, Sawano M. Effect of ionized calcium level on short-term prognosis in severe multiple trauma patients: a clinical study. Trauma Surg Acute Care Open. 2023;8:e001083.
pubmed: 37396952
pmcid: 10314608
doi: 10.1136/tsaco-2022-001083
Matthay ZA, Fields AT, Nunez-Garcia B, Patel MH, Cohen MJ, Callcut RA, et al. Dynamic effects of calcium on in vivo and ex vivo platelet behavior after trauma. J Trauma Acute Care Surg. 2020;89:871–9.
pubmed: 32852184
pmcid: 7830742
doi: 10.1097/TA.0000000000002820
Thies KC, Truhlář A, Keene D, Hinkelbein J, Rützler K, Brazzi L, et al. Pre-hospital blood transfusion-an ESA survey of European practice. Scand J Trauma Resusc Emerg Med. 2020;28:1–8.
doi: 10.1186/s13049-020-00774-1
Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res. 2011;46:399–424.
pubmed: 21818162
pmcid: 3144483
doi: 10.1080/00273171.2011.568786
Imach S, Wafaisade A, Lefering R, Böhmer A, Schieren M, Suárez V, et al. The impact of prehospital tranexamic acid on mortality and transfusion requirements: match-pair analysis from the nationwide German TraumaRegister DGU
doi: 10.1186/s13054-021-03701-7
Zakrison TL, Austin PC, McCredie VA. A systematic review of propensity score methods in the acute care surgery literature: avoiding the pitfalls and proposing a set of reporting guidelines. Eur J Trauma Emerg Surg. 2018;44:385–95.
pubmed: 28342097
doi: 10.1007/s00068-017-0786-6
Lefering R, Huber-wagner S, Nienaber U, Maegele M, Bouillon B. Update of the trauma risk adjustment model of the TraumaRegister DGU
pubmed: 25394596
pmcid: 4177428
doi: 10.1186/s13054-014-0476-2
Lefering R, Huber-Wagner S, Bouillon B, Lawrence T, Lecky F, Bouamra O. Cross-validation of two prognostic trauma scores in severely injured patients. Eur J Trauma Emerg Surg. 2020;47:1837.
pubmed: 32322925
pmcid: 8629869
doi: 10.1007/s00068-020-01373-6
Pape HC, Lefering R, Butcher N, Peitzman A, Leenen L, Marzi I, et al. The definition of polytrauma revisited: an international consensus process and proposal of the new “Berlin definition.” J Trauma Acute Care Surg. 2014;77:780–6.
pubmed: 25494433
doi: 10.1097/TA.0000000000000453
Moore EE, Moore HB, Kornblith LZ, Neal MD, Hoffman M, Mutch NJ, et al. Trauma-induced coagulopathy. Nat Rev Dis Prim. 2021;7:30.
pubmed: 33927200
doi: 10.1038/s41572-021-00264-3
Polytrauma Guideline Update Group. Level 3 guideline on the treatment of patients with severe/multiple injuries: AWMF Register-Nr. 012/019. Eur J Trauma Emerg Surg. 2018;44(Suppl 1):3.
doi: 10.1007/s00068-018-0922-y
Pape HC, Moore EE, McKinley T, Sauaia A. Pathophysiology in patients with polytrauma. Injury. 2022;53:2400–12.
pubmed: 35577600
doi: 10.1016/j.injury.2022.04.009
Simpson R, Praditsuktavorn B, Wall J, Morales V, Thiemermann C, Tremoleda JL, et al. Myocardial alterations following traumatic hemorrhagic injury. J Trauma Acute Care Surg. 2023;95:481–9.
pubmed: 37249511
doi: 10.1097/TA.0000000000003987
Davenport R, Curry N, Fox E, Lucas J, Evans A, Shanmugaranjan S, et al. Early and empirical high-dose cryoprecipitate for hemorrhage after traumatic injury: the CRYOSTAT-2 randomized clinical trial. JAMA. 2023;330:1882–91.
pubmed: 37824155
pmcid: 10570921
doi: 10.1001/jama.2023.21019
Bouzat P, Charbit J, Abback PS, Huet-Garrigue D, Delhaye N, Leone M, et al. Efficacy and safety of early administration of 4-factor prothrombin complex concentrate in patients with trauma at risk of massive transfusion: the PROCOAG randomized clinical trial. JAMA. 2023;329:1367–75.
pubmed: 36942533
pmcid: 10031505
doi: 10.1001/jama.2023.4080
Kivimäki M, Singh-Manoux A, Ferrie JE, David BG. Post hoc decision-making in observational epidemiology-is there need for better research standards? Int J Epidemiol. 2013;42:367–70.
pubmed: 23569177
pmcid: 3619956
doi: 10.1093/ije/dyt036
Wang X, Piantadosi S, Le-Rademacher J, Mandrekar SJ. Statistical considerations for subgroup analyses. J Thorac Oncol. 2021;16:375–80.
pubmed: 33373692
doi: 10.1016/j.jtho.2020.12.008
Hiemstra B, Keus F, Wetterslev J, Gluud C, Van Der Horst ICC. DEBATE-statistical analysis plans for observational studies. BMC Med Res Methodol. 2019;19:1–10.
doi: 10.1186/s12874-019-0879-5
James MFM, Roche AM. Dose-response relationship between plasma ionized calcium concentration and thrombelastography. J Cardiothorac Vasc Anesth. 2004;18:581–6.
pubmed: 15578468
doi: 10.1053/j.jvca.2004.07.016
Vallentin MF, Granfeldt A, Meilandt C, Povlsen AL, Sindberg B, Holmberg MJ, et al. Effect of intravenous or intraosseous calcium vs saline on return of spontaneous circulation in adults with out-of-hospital cardiac arrest: a randomized clinical trial. JAMA. 2021;326:2268–76.
pubmed: 34847226
doi: 10.1001/jama.2021.20929
Kelly A, Levine MA. Hypocalcemia in the critically ill patient. J Intensive Care Med. 2013;28:166–77.
pubmed: 21841146
doi: 10.1177/0885066611411543
Zhang Z, Xu X, Ni H, Deng H. Predictive value of ionized calcium in critically ill patients: an analysis of a large clinical database mimic ii. PLoS ONE. 2014;9:e95204.
pubmed: 24736693
pmcid: 3988144
doi: 10.1371/journal.pone.0095204
Yan D, Xie X, Fu X, Pei S, Wang Y, Deng Y, et al. U-shaped association between serum calcium levels and 28-day mortality in patients with sepsis: a retrospective analysis of the MIMIC-III database. Shock. 2023;60:525–33.
pubmed: 37566809
pmcid: 10581423
doi: 10.1097/SHK.0000000000002203
Qin X, Cen J, Hu H, Chen X, Wei Z, Wan Q, et al. Non-linear relationship between albumin-corrected calcium and 30-day in-hospital mortality in ICU patients: a multicenter retrospective cohort study. Front Endocrinol. 2022;13:1–11.
doi: 10.3389/fendo.2022.1059201
Collage RD, Howell GM, Zhang X, Stripay JL, Lee JS, Angus DC, et al. Calcium supplementation during sepsis exacerbates organ failure and mortality via calcium/calmodulin-dependent protein kinase kinase signaling. Crit Care Med. 2013;41:6–10.
doi: 10.1097/CCM.0b013e31828cf436
Sood A, Singh G, Singh TG, Gupta K. Pathological role of the calcium-sensing receptor in sepsis-induced hypotensive shock: therapeutic possibilities and unanswered questions. Drug Dev Res. 2022;83:1241–5.
pubmed: 35689439
doi: 10.1002/ddr.21959
Forsythe RM, Wessel CB, Billiar TR, Angus DC, Rosengart MR. Parenteral calcium for intensive care unit patients. Cochrane Database Syst Rev. 2008. https://doi.org/10.1002/14651858.CD006163.pub2 .
doi: 10.1002/14651858.CD006163.pub2
pubmed: 18843706
Aberegg SK. Ionized calcium in the ICU should it be measured and corrected? Chest. 2016;149:846–55.
pubmed: 26836894
doi: 10.1016/j.chest.2015.12.001
Malcolm DS, Zaloga GP, Holaday JW. Calcium administration increases the mortality of endotoxic shock in rats. Crit Care Med. 1989;17(9):900–3.
pubmed: 2504540
doi: 10.1097/00003246-198909000-00012
Carlstedt F, Eriksson M, Kiiski R, Larsson A, Lind L. Hypocalcemia during porcine endotoxemic shock: effects of calcium administration. Crit Care Med. 2000;28:2909–14.
pubmed: 10966270
doi: 10.1097/00003246-200008000-00037
Reiffel JA. Propensity score matching: the ‘devil is in the details’ where more may be hidden than you know. Am J Med. 2020;133:178–81.
pubmed: 31618617
doi: 10.1016/j.amjmed.2019.08.055