Transfusion-Related Hypocalcemia After Trauma.

Area of Science:

• Trauma critical care
• Transfusion medicine
• Critical care medicine

Background:

• Hypocalcemia is a known complication of massive transfusions.
• Its role as a primary outcome in trauma patients requires further investigation.

Purpose of the Study:

• To determine if packed red blood cell (pRBC) transfusion is an independent predictor of severe hypocalcemia (SH) in trauma patients.
• To identify risk factors associated with SH and its impact on mortality.

Main Methods:

• Retrospective, single-center study (2004-2014) of trauma patients (≥18 years) with recorded ionized calcium (iCa) levels.
• Regression models were used to identify independent risk factors for SH (iCa ≤ 3.6 mg/dL).

Main Results:

• 9.8% of 7,431 trauma patients developed SH within 48 hours.
• SH was associated with lower GCS, hypotension, tachycardia, and higher rates of emergency surgery.
• Independent predictors of SH included penetrating mechanism, higher Injury Severity Score (ISS), and increased pRBC or FFP administration.
• SH independently predicted mortality (AOR: 2.658).
• A significantly higher risk of SH was identified with pRBC + FFP administration of 4 units (AOR: 18.706).

Conclusions:

• Transfusion of pRBC is an independent predictor of SH in trauma patients.
• Increased pRBC and FFP administration is associated with a higher risk of SH and increased mortality.