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Elevated K/iCa ratio is an ancillary predictor for mortality in patients with severe hemorrhage: A decision tree analysis

Elevated K/iCa ratio is an ancillary predictor for mortality in patients with severe hemorrhage: A decision tree analysis

Authors :
Scott Ninokawa
Danielle Tatum
Eman Toraih
Kristen Nordham
Michael Ghio
Sharven Taghavi
Chrissy Guidry
Patrick McGrew
Rebecca Schroll
Charles Harris
Juan Duchesne
Source :
American journal of surgery. 223(6)
Publication Year :
2021

Abstract

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.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.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).Elevated K/iCa ratio was an independent predictor of mortality in trauma patients managed with MTP.

Details

ISSN :
18791883
Volume :
223
Issue :
6
Database :
OpenAIRE
Journal :
American journal of surgery
Accession number :
edsair.doi.dedup.....f671657e6fce361f79dbb70098d9aebd