神経学的障害

Hypocalcaemia as a Prognostic Factor of Mortality and Morbidity in Moderate and severe Traumatic Brain Injury and its role with Protein S-100b

Abstract

Vinas-Rios JM, Kretschmer T, Sanchez-Aguilar M, Roeller Y, Sanchez-Rodriguez JJ, Medina-Govea Fatima Azucena,Heinen CPG

Introduction: The effects of traumatic brain injury (TBI) can result in severe disability or death and have an important social and economic impact. Its annual direct and indirect costs amount to roughly 2.5 billion euros. Our objective was to evaluate whether hypocalcaemia of serum ionized calcium (defined as <1.10 mmol/L (4.5 mg/dL) is a prognostic factor for mortality and morbidity (defined as GOS ≤ 3) in early moderate and severe TBI.

Material and methods: Prospective study from January 2014 to December 2015. Patients were between 16 and 87 years old and had a Glasgow Coma Scale (GCS) of 3-13 points following TBI, with demonstrable intracranial lesions in cranial computed tomography (CT).

Results: We recruited 61 patients who suffered moderate and severe TBI with a median age of 42 years old (range: 17 to 86). Forty-three (70.50%) male 18 (29.50%) female. Twenty-one (34.42%) patients had a GOS ≤ 3 and 40 (65.58%) a GOS >3. We found a significant statistical difference (0.009) in ionized serum calcium, Protein S-100b (0.002), IL 6 (0.007) and Haemoglobin (0.011) on day three of admission between GOS ≤ 3 and >3 (disability/death). The best logistic regression model included: age, absent pupillary reactivity, hypocalcaemia of ionized serum calcium (<1.10 mmol/L), Protein S100 b and IL6 on day three.

Conclusion: Hypocalcaemia looks like being an epiphenomenon of several factors. It seems to play a role as prognosticator, however not as leverage point for therapy.