Total-to-ionized calcium ratio predicts mortality in continuous renal replacement therapy with citrate anticoagulation in critically ill patients

Link, Andreas; Klingele, Matthias; Speer, Timo; Rbah, Ranja; Pöss, Janine; Lerner-Gräber, Anne; Fliser, Danilo; Böhm, Michael

doi:10.1186/cc11363

Critical Care

Table 2 Laboratory parameters at start, day 3, and last day of continuous renal replacement therapy

From: Total-to-ionized calcium ratio predicts mortality in continuous renal replacement therapy with citrate anticoagulation in critically ill patients

Parameters	T/I-Ca²⁺ ratio									Bonferroni post hoc test
	<2.0			2.0-2.39			≥2.4			Tertile 1 versus tertile 2	Tertile 1 versus tertile 3	Tertile 2 versus tertile 3
	n = 65			n = 90			n = 53
	First day	Day 3	Last day				First day	Day 3	Last day
Critical illness score, hemodynamics										P values
SAPS II, points	46 ± 1.21	35 ± 1.45	33 ± 1.07	47 ± 1.18	44 ± 1.38	42 ± 1.63	49 ± 1.27	59 ± 1.38	60 ± 1.41	<0.001	<0.001	<0.001
Heart rate, beats per minute	89 ± 2.37	88 ± 2.36	77 ± 2.33	90 ± 1.79	89 ± 1.82	81 ± 2.42	98 ± 2.66	97 ± 2.65	104 ± 3.07	0.324	<0.001	<0.001
MAP, mm Hg	76.34 ± 1.83	76.34 ± 1.38	79.88 ± 1.69	71.82 ± 1.15	71.71 ± 1.15	73.16 ± 1.19	68.60 ± 1.29	68.61 ± 1.30	67.28 ± 1.50	<0.001	<0.001	<0.001
Liver function
Bilirubin, mg/dL	2.21 ± 0.66	2.28 ± 0.66	3.09 ± 0.81	2.63 ± 0.57	2.60 ± 0.58	2.99 ± 0.50	5.74 ± 1.30	6.09 ± 1.22	7.09 ± 1.25	0.799	<0.001	<0.001
Albumin, g/L	26.42 ± 0.73	25.82 ± 0.66	26.12 ± 0.72	28.11 ± 0.71	28.02 ± 0.65	27.33 ± 0.61	28.11 ± 0.86	27.42 ± 0.82	25.19 ± 0.86	0.003	0.258	0.118
CHE × 10³, U/L	4.52 ± 0.23	4.52 ± 0.23	4.44 ± 0.23	4.31 ± 0.20	4.29 ± 0.20	4,12 ± 0.19	3.93 ± 0.25	3.93 ± 0.25	3.85 ± 0.25	0.159	0.001	0.035
Prothrombin time, percentage	63.12 ± 3.00	72.83 ± 2.86	72.25 ± 2.79	60.12 ± 2.42	60.60 ± 2.48	61.88 ± 2.66	50.23 ± 3.12	52.59 ± 3.15	49.15 ± 3.27	<0.001	<0.001	<0.001
AT III, percentage	69.71 ± 2.18	69.70 ± 2.17	70.37 ± 2.19	68.90 ± 2.21	68.84 ± 2.21	69.09 ± 2.25	58.45 ± 3.09	58.45 ± 3.09	57.59 ± 3.11	0.471	<0.001	<0.001
ASAT, U/L	449 ± 144	298 ± 108	186 ± 95	296 ± 78	404 ± 97	520 ± 126	817 ± 304	763 ± 209	1,237 ± 379	0.360	<0.001	<0.001
ALAT, U/L	204 ± 74	163 ± 59	119 ± 56	180 ± 48	239 ± 52	251 ± 53	431 ± 174	446 ± 121	462 ± 115	0.544	0.072	<0.001
γ-GT, U/L	133 ± 18	125 ± 17	222 ± 34	144 ± 18	133 ± 15	199 ± 30	121 ± 20	129 ± 20	127 ± 19	0.519	0.072	0.188
ICG-PDR, percentage/minute	15.02 ± 0.61	18.78 ± 0.43	19.60 ± 0.58	13.93 ± 0.47	15.26 ± 0.55	16.04 ± 0.65	11.16 ± 0.64	9.26 ± 0.56	8.83 ± 0.55	<0.001	<0.001	<0.001
Dialysis function, mg/dL
Urea	123.03 ± 8.31	63.71 ± 5.13	53.79 ± 5.01	115.48 ± 7.78	58.97 ± 3.62	47.49 ± 3.24	121.38 ± 9.22	63.83 ± 5.00	54.55 ± 5.15	0.295	0.995	0.324
Blood urea nitrogen	57.46 ± 3.88	29.75 ± 2.39	25.12 ± 2.34	53.93 3.64	27.54 ± 1.69	22.18 ± 1.51	56.48 ± 4.77	29.81 ± 2.34	25.48 ± 2.41	0.295	0.995	0.324
Creatinine	4.14 ± 0.29	2.14 ± 0.16	1.77 ± 0.16	3.14 ± 0.20	1.75 ± 0.10	1.59 ± 0.10	3.07 ± 0.28	1.88 ± 0.11	1.65 ± 0.11	0.002	0.009	0.867
Ca homeostasis and chloride
Ca²⁺ extracorporeal, mmol/L	0.29 ± 0.01	0.29 ± 0.01	0.29 ± 0.01	0.29 ± 0.01	0.30 ± 0.01	0.30 ± 0.01	0.29 ± 0.01	0.30 ± 0.01	0.30 ± 0.01	0.586	0.096	0.189
Total Ca²⁺, mmol/L	1.97 ± 0.03	2.07 ± 0.03	2.10 ± 0.03	2.14 ± 0.02	2.29 ± 0.03	2.25 ± 0.03	2.30 ± 0.03	2.49 ± 0.03	2.42 ± 0.05	<0.001	<0.001	<0.001
Ionized Ca²⁺, mmol/L	1.04 ± 0.02	1.11 ± 0.01	1.11 ± 0.01	1.04 ± 0.01	1.06 ± 0.02	1.05 ± 0.01	0.98 ± 0.02	0.99 ± 0.01	0.98 ± 0.02	<0.001	<0.001	<0.001
T/I-Ca²⁺ ratio	1.90 ± 0.02	1.87 ± 0.01	1.89 ± 0.02	2.07 ± 0.02	2.16 ± 0.01	2.15 ± 0.02	2.36 ± 0.04	2.53 ± 0.02	2.49 ± 0.04	<0.001	<0.001	<0.001
Chloride, mmol/L	108 ± 0.45	107 ± 0.58	107 ± 0.62	108 ± 0.51	108 ± 0.78	107 ± 0.54	108 ± 0,36	107 ± 0.55	108 ± 0.34	0.587	0.781	0.672
Acid-base balance
pH	7.38 ± 0.01	7.43 ± 0.01	7.43 ± 0.01	7.40 ± 0.01	7.43 ± 0.01	7.42 ± 0.01	7.37 ± 0.01	7.41 ± 0.01	7.39 ± 0.01	0.384	<0.001	<0.001
pCO₂, mm Hg	38.77 ± 1.48	37.81 ± 0.78	38.09 ± 0.72	35.59 ± 0.69	37.61 ± 0.60	39.25 ± 0.69	35.81 ± 0.98	37.98 ± 0.86	38.59 ± 1.22	0.242	0.301	0.994
HCO₃, mm Hg	22.77 ± 0.53	25.10 ± 0.36	25.61 ± 0.54	22.41 ± 0.38	24,34 ± 0.36	25.28 ± 0.46	20.68 ± 0.42	23.13 ± 0.54	23.40 ± 0.67	0.273	<0.001	<0.001
Hematology
Hemoglobin, g/dL	10.29 ± 0.26	9.24 ± 0.22	9.24 ± 0.22	10.30 ± 0.19	9.98 ± 0.27	9.98 ± 0.27	10.14 ± 0.28	9.56 ± 0.25	9.54 ± 0.25	0.009	0.495	0.081
Platelets, 10⁹/L	164 ± 10.67	147 ± 9.51	152 ± 10.99	147 ± 8.96	135 ± 7.94	127 ± 8.22	122 ± 12.88	101 ± 12.18	77 ± 10.58	0.025	<0.001	<0.001

Data are presented as mean ± standard error of the mean. Quantitative data were analyzed by Bonferroni post hoc test. γ-GT, gamma-glutamylcyclotransferase; ALAT, alanine aminotransferase; ASAT, aspartate aminotransferase; AT III, antithrombin III; CHE, cholinesterase; HCO₃, bicarbonate; ICG-PDR, indocyanine green plasma disappearance rate; MAP, mean arterial pressure; pCO₂, carbon dioxide partial pressure; SAPS II, Simplified Acute Physiology Score II; T/I-Ca²⁺ ratio, total-to-ionized calcium ratio.

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