gms | German Medical Science

Objective: Annually, approximately 10 million people are affected by traumatic brain injury (TBI) worldwide. As a leading cause of death and disability worldwide, there is an increasing interest in the use of predictive markers to estimate the outcome in adult TBI. We therefore investigated the effects of hypocalcaemia in early phases after moderate to severe TBI and postulated a pathophysiological (Figure 1 [Fig. 1]) pattern leading to posttraumatic hypocalcaemia which we subsequently compared to present literature.

Methods: Data from 282 patients (180 retrospective and 102 prospective) suffering from moderate to severe TBI were collected and analyzed. Patients between the age of 16 to 87 were included. Additional inclusion cirterias were: A Glasgow Coma Scale (GCS) from 3 to 13 points, Cranial Computed Tomography (CCT) upon admission and Calcium and/or ionized calcium measurements taken on the day of TBI, as well as on days 3 and 7.

Results: Contrary to our expectations and previous experience with 122 patients from Mexico, values of non-ionized serum calcium did not show any significant outcome correlation in our cohort of German patients, though ionized serum calcium did show a significant correlation predicting mortality and morbidity in patients suffering from TBI.

Conclusion: Hypocalcaemia is a reliable marker for the depth of brain damage as a result of a cascade of various pathologic mechanisms such as direct mechanical trauma, neuro-inflammation, altered vessel-autoregulation and hypoxia and therefore should be considered in TBI.