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

Scott Ninokawa; Danielle Tatum; Eman Toraih; Kristen Nordham; Michael Ghio; Sharven Taghavi; Chrissy Guidry; Patrick McGrew; Rebecca Schroll; Charles Harris; Juan Duchesne

doi:10.1016/j.amjsurg.2021.12.011

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

Am J Surg. 2022 Jun;223(6):1187-1193. doi: 10.1016/j.amjsurg.2021.12.011. Epub 2021 Dec 14.

Authors

Affiliations

¹ Tulane University School of Medicine, Department of Surgery, New Orleans, LA, USA. Electronic address: [email protected].
² Tulane University School of Medicine, Department of Surgery, New Orleans, LA, USA; Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA. Electronic address: [email protected].
³ Tulane University School of Medicine, Department of Surgery, New Orleans, LA, USA; Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt. Electronic address: [email protected].
⁴ Tulane University School of Medicine, Department of Surgery, New Orleans, LA, USA. Electronic address: [email protected].
⁵ Tulane University School of Medicine, Department of Surgery, New Orleans, LA, USA. Electronic address: [email protected].
⁶ Tulane University School of Medicine, Department of Surgery, New Orleans, LA, USA. Electronic address: [email protected].
⁷ Tulane University School of Medicine, Department of Surgery, New Orleans, LA, USA. Electronic address: [email protected].
⁸ Tulane University School of Medicine, Department of Surgery, New Orleans, LA, USA. Electronic address: [email protected].
⁹ Tulane University School of Medicine, Department of Surgery, New Orleans, LA, USA. Electronic address: [email protected].
¹⁰ Tulane University School of Medicine, Department of Surgery, New Orleans, LA, USA. Electronic address: [email protected].
¹¹ Tulane University School of Medicine, Department of Surgery, New Orleans, LA, USA. Electronic address: [email protected].

PMID: 34930584
DOI: 10.1016/j.amjsurg.2021.12.011

Abstract

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.

Keywords: Hyperkalemia; Hypocalcemia; K/iCa ratio; Massive transfusion protocol; Trauma.

MeSH terms

Adult
Blood Transfusion / methods
Decision Trees
Hemorrhage
Humans
Retrospective Studies
Trauma Centers*
Wounds and Injuries* / complications