Summary

Restrictive calcium replacement in septic shock: a multicenter before-after intervention study

Ryoung-Eun Ko1, Daun Jeong2,3, Sumin Baek4, Chi Ryang Chung1, Gee Young Suh1,5, Joonghyun Ahn6, Jinseo Kim6, Sung Yeon Hwang3, Gun Tak Lee3, Jong Eun Park3, Tae Gun Shin3, You Hwan Jo4, Korean Shock Society (KoSS) Investigators

Affiliation of the authors

1Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seul, Republic of Korea. 2Department of Critical Care Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seul, Republic of Korea. 3Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seul, Republic of Korea. 4Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seul, Republic of Korea. 5Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seul, Republic of Korea. 6Biomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seul, Republic of Korea.

DOI

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Quote

Ko RE, Jeong D, Baek S, Ryang Chung C, Young Suh G, Ahn J, et al. Restrictive calcium replacement in septic shock: a multicenter before-after intervention study. Emergencias. 2024;36:204-10

Summary

Purpose. To study the impact of a restrictive calcium replacement protocol in comparison with a liberal one in patients with septic shock.

Methods.

Multicenter retrospective before-after study that estimated the impact of implementing a restrictive calcium replacement protocol in patients with septic shock. Patients admitted to an intensive care unit between May 2019 and April 2021 were assigned to liberal calcium replacement, and those admitted between May 2021 and April 2022 were assigned to a restrictive protocol. The primary outcome measure was 28-day mortality. Patients were matched with propensity scores.

Results.

A total of 644 patients were included; liberal replacement was used in 453 patients and the restrictive replacement in 191. We paired 553 patients according to propensity scores, 386 in the liberal group and 167 in the restrictive group. Mortality did not differ significantly between the groups at 28 days (35.3% vs 32.3%, respectively; hazard ratio, 0.97; 95% CI, 0.72-1.29) or after resolution of septic shock (81.5% vs 83.8%; hazard ratio, 0.89; 95% CI, 0.73-1.09). Nor did scores on the Sepsis-related Organ Failure Assessment scale differ (2.1 vs 2.6; P = 0.20).

Conclusions.

The implementation of a restrictive calcium replacement protocol in patients with septic shock was not associated with a decrease in 28-day mortality in comparison with use of a liberal protocol. However, we were able to reduce calcium replacement without adverse effects.

 

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