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Elevated K/iCa ratio is an ancillary predictor for mortality in patients with severe hemorrhage: A decision tree
Scott Ninokawa1, Danielle Tatum2, Eman Toraih3
1Tulane University School of Medicine, Department of Surgery, New Orleans, LA, USA.
Insights
Massive transfusion in trauma patients can cause electrolyte imbalances. A high potassium to ionized calcium (K/iCa) ratio at admission predicts mortality in these patients, indicating a need for closer monitoring.
Area of Science:
- Trauma critical care
- Transfusion medicine
- Clinical pathology
Background:
- Massive transfusion protocol (MTP) in trauma patients carries risks of citrate-induced hypocalcemia and hyperkalemia.
- Monitoring electrolyte levels is crucial for managing these patients.
Purpose of the Study:
- To evaluate potassium (K), ionized calcium (iCa), and the K/iCa ratio as predictors of mortality in trauma patients receiving MTP.
Main Methods:
- Retrospective study of adult trauma patients who received MTP within 1 hour.
- Analysis included 614 patients (146 received MTP) from 2014-2019.
- Receiver operating characteristic (ROC) curve analysis assessed the K/iCa ratio's predictive accuracy for 120-day mortality.
Main Results:
- Patients who expired had a significantly higher K/iCa ratio (median [IQR] 5.7 [3.8-7.2]) compared to survivors (3.7 [3.1-4.9]).
- The K/iCa ratio demonstrated good predictive accuracy (AUC=0.72) for mortality.
- An elevated K/iCa ratio (cutoff 5.07) was associated with a 4-fold increased mortality risk (HR=3.97).
Conclusions:
- The K/iCa ratio is an independent predictor of mortality in trauma patients managed with MTP.
- This ratio can aid in identifying high-risk patients early.
- Further research may explore interventions to mitigate risks associated with elevated K/iCa ratios.
Introduction:
Trauma patients receiving massive transfusion protocol (MTP) are at risk of citrate-induced hypocalcemia and hyperkalemia. Here we evaluate potassium (K), ionized calcium (iCa), and K/iCa ratio as predictors of mortality.
Methods:
This retrospective study includes all adult trauma patients who received MTP within 1 h at our level I trauma center between 2014 and 2019. Receiver operating characteristic curve analysis assessed predictive accuracy of K/iCa ratio at admission on 120-day mortality.
Results:
Of 614 patients, 146 received MTP within 1 h and 38 expired. Patients who expired had higher K/iCa ratio than survivors (median [IQR] = 5.7 [3.8-7.2] vs 3.7 [3.1-4.9], p < 0.001). Area under the curve of K/iCa was 0.72 (95%CI = 0.62-0.82, p < 0.001) with sensitivity = 63.2% and specificity = 77.6%. At the optimum K/iCa cutoff (5.07), patients with high ratios had 4 times higher mortality risk (HR = 3.97, 95%CI = 1.89-8.32, p < 0.001).
Conclusion:
Elevated K/iCa ratio was an independent predictor of mortality in trauma patients managed with MTP.
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