Ionized hypocalcemia as a prognostic factor of early mortality in traumatic brain injury

ABSTRACT

Traumatic brain injury (TBI) is a common neurological condition. It can affect mental, physical, and cognitive functions and is a common cause of mortality. Electrolytes imbalance is common in those patients. Effective therapy of electrolytes abnormalities improves neurological outcome and reduces mortality. Therefore, we studied the predictive significance of ionized hypocalcemia for early mortality in TBI patients.

Patients and method

This observational study in the intensive care units of the Ain Shams University hospitals was done on sixty adult patients with TBI of both sexes, divided into two groups: group A (ionized hypocalcemic patients), and group B (normocalcemic patients). On admission, medical history, physical examination including neurological evaluation, and appropriate investigations were performed. Ionized calcium was measured at the start of the 28-day study and then every five days after that.

Results

There was no statistically significant difference between the two groups for demographic data, brain injury type, or the number of intubated patients (p > 0.05). There was a statistically significant difference for diffuse axonal damage, subdural hemorrhage, cerebral edema, GCS, and mean blood pressure (p < 0.001). Serum ionized calcium in group A was significantly lower than in group B on the day of admission and day five (p < 0.001). On the day of admission, there was a significant difference in serum sodium (p < 0.05). In both groups, there was a significant difference in the ICU stay as regards survivors (p < 0.001). There was a statistically significant difference in 28-day mortality between the two groups (p = 0.001).

Conclusion

In TBI patients, ionized hypocalcemia on admission and on day five, hypernatremia and disturbed conscious level are strongly linked to greater fatality rates.

KEYWORDS:

• Traumatic brain injury
• ionized hypocalcemia
• mortality

Disclosure statement

No potential conflict of interest was reported by the author(s).

Contribution from authors

Gamal Eldin Mohammad Ahmad Elewa, Mohamed Sidky Mahmoud Zaki, Sherif George Anis Said, Ahmed Abd El Ghani Khalifa Ragab contributed substantially in the designing of the research; creating the ideas; editing and reviewing the paper. Jihad Mamdouh Mahanna Ahmed : contributed mainly in performing the procedures of the experiment; analyzing and interpreting the data; as well as writing the paper.

Financial support

Sponsoring institutions in the private, public, or nonprofit sectors did not provide any specific money for this study.