Hypocalcemia as a predictor of mortality and transfusion. A scoping review of hypocalcemia in trauma and hemostatic resuscitation

Shane Kronstedt, Nicholas Roberts, Ricky Ditzel, Justin Elder, Aimee Steen, Kelsey Thompson, Justin Anderson, Jeffrey Siegler, Shane Kronstedt, Nicholas Roberts, Ricky Ditzel, Justin Elder, Aimee Steen, Kelsey Thompson, Justin Anderson, Jeffrey Siegler

Abstract

Background: Calcium plays an essential role in physiologic processes, including trauma's "Lethal Diamond." Thus, inadequate serum calcium in trauma patients exacerbates the effects of hemorrhagic shock secondary to traumatic injury and subsequently poorer outcomes compared to those with adequate calcium levels. Evidence to date supports the consideration of calcium derangements when assessing the risk of mortality and the need for blood product transfusion in trauma patients. This review aims to further elucidate the predictive strength of this association for future treatment guidelines and clinical trials.

Methods: Publications were collected on the relationship between i-Ca and the outcomes of traumatic injuries from PubMed, Web of Science, and CINAHL. Manuscripts were reviewed to select for English language studies. Hypocalcemia was defined as i-Ca <1.2 mmol/L.

Results: Using PRISMA guidelines, we reviewed 300 studies, 7 of which met our inclusion criteria. Five papers showed an association between hypocalcemia and mortality.

Conclusions: In adult trauma patients, there has been an association seen between hypocalcemia, mortality, and the need for increased blood product transfusions. It is possible we are now seeing an association between low calcium levels prior to blood product administration and an increased risk for mortality and need for transfusion. Hypocalcemia may serve as a biomarker to show these needs. Therefore, hypocalcemia could potentially be used as an independent predictor for multiple transfusions such that ionized calcium measurements could be used predictively, allowing faster administration of blood products.

Keywords: hypocalcemia; military; mortality; transfusion; trauma.

Conflict of interest statement

The authors have no conflicts to declare.

© 2022 The Authors. Transfusion published by Wiley Periodicals LLC on behalf of AABB.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram. Legend: The PRISMA diagram details the search and selection process applied during the scoping review

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Source: PubMed

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