Vaidyanathan Ramesh, Rani Preksha, Manwatkar Shrikanth, Singh J K, Gora Dinesh, Kushwaha Pranabh, Priyadarshini Pratyusha, Bagaria Dinesh, Choudhary Narendra, Alam Junaid, Selvi Arul, Kumar Anand, Soni Kapil Dev, Sagar Sushma, Kumar Subodh, Gupta Amit, Mishra Biplab, Kumar Abhinav, Khan Mahroof
Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences [AIIMS], Room 217 Second Floor, New Delhi, India.
Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Eur J Trauma Emerg Surg. 2025 Jan 14;51(1):16. doi: 10.1007/s00068-024-02713-6.
Haemorrhage remains the leading cause of preventable mortality following trauma, often aggravated by the acidosis, hypothermia and coagulopathy-the lethal triad of trauma. However, the impact of trauma-induced hypocalcemia on the haemorrhage remains unclear. It is intuitive to consider perturbations of ionised calcium early during trauma resuscitation in acutely injured patients given its pathophysiological significance for an improved outcome. Thus, we conducted a prospective study to analyse the role of ionized calcium ion levels during trauma resuscitation and its association with the need for blood transfusion(s) requirement and mortality.
A prospective study was conducted on acutely injured patients with haemorrhage getting admitted to a Level 1 trauma center in India between September 2020 and June 2022. Ionised calcium was measured on arrival, after 6 h, and on day two of the injury to assess the prevalence. The amount of blood transfusion received by the patient was noted along with other demographic and in-hospital details. The association of hypocalcemia with blood transfusion and mortality was also evaluated.
Of the 1961 patients screened for eligibility, 200 patients were recruited and analysed. 72.5% of patients were hypocalcaemic on emergency department (ED) admission. Ionized hypocalcaemia was significantly associated with the need for blood transfusion(s) (p-value < 0.01). A significant association was also noted between ionized hypocalcaemia and mortality (p-value: 0.0085). On the univariate and multivariable analysis, ionized hypocalcaemia was a significant predictor of mortality.
Ionized hypocalcaemia is widely prevalent among acutely injured. Trauma-induced hypocalcaemia at admission is associated with increased need for blood transfusions and increased mortality.
出血仍然是创伤后可预防死亡的主要原因，常因酸中毒、体温过低和凝血病（创伤致死三联征）而加重。然而，创伤诱导的低钙血症对出血的影响仍不清楚。鉴于其对改善急性受伤患者创伤复苏结局的病理生理意义，在创伤复苏早期考虑离子钙的紊乱是合理的。因此，我们进行了一项前瞻性研究，以分析创伤复苏期间离子钙水平的作用及其与输血需求和死亡率的关系。
对2020年9月至2022年6月期间入住印度一家一级创伤中心的急性出血受伤患者进行了一项前瞻性研究。在患者到达时、6小时后以及受伤后第二天测量离子钙，以评估其发生率。记录患者接受的输血量以及其他人口统计学和住院细节。还评估了低钙血症与输血和死亡率的关系。
在筛选符合条件的1961名患者中，招募并分析了200名患者。72.5%的患者在急诊科入院时存在低钙血症。离子钙低血症与输血需求显著相关（p值<0.01）。离子钙低血症与死亡率之间也存在显著关联（p值：0.0085）。在单变量和多变量分析中，离子钙低血症是死亡率的显著预测因素。
离子钙低血症在急性受伤患者中广泛存在。入院时创伤诱导的低钙血症与输血需求增加和死亡率增加相关。
