Department of Anesthesia and Emergency Medicine, AZ Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium.
Department of Cardiovascular Sciences, Kulak University Kortrijk Campus, Etienne Sabbelaan 53, Box 7700, 8500, Kortrijk, Belgium.
Crit Care. 2024 Jul 5;28(1):222. doi: 10.1186/s13054-024-05002-1.
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 (2015-2019), applying propensity score matching to balance demographics, injury severity, and management between major trauma patients with and without calcium supplementation. 6 h mortality, 24 h mortality, and in-hospital mortality were considered as primary outcome parameters.
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.
在严重创伤患者中，低钙血症与死亡率增加相关。尽管缺乏因果关系的有力证据，但早期补钙已被推荐。本研究旨在探讨创伤复苏期间补钙是否能带来生存获益。
我们使用来自创伤登记处 DGU（2015-2019 年）的数据进行回顾性分析，通过倾向评分匹配来平衡严重创伤患者中有无钙补充的人群的人口统计学、损伤严重程度和治疗差异。主要结局参数为 6 小时死亡率、24 小时死亡率和住院死亡率。
在欧洲一家创伤中心直接收治的 28323 例成年严重创伤患者队列中，有 1593 例（5.6%）接受了钙补充。使用多变量逻辑回归生成倾向评分后，可匹配两组各 1447 例可比患者。两组早期死亡率（6 小时和 24 小时）无显著差异，但补钙组住院死亡率更高（28.3%比 24.5%，P=0.020），但调整预测死亡率后无统计学意义（P=0.244）。
在本匹配队列中，未发现创伤复苏期间补钙能带来生存获益的证据或相反证据。进一步的研究应重点关注严重创伤患者离子钙水平的动态和动力学，并确定是否存在特定条件或亚组可从钙补充中获益。
