Prognostic Performance of the Lactate-to-Ionized Calcium Ratio for In-Hospital Mortality in Adult Major…

Cohort studyDiagnostics (Basel, Switzerland)· Jul 2026

Prognostic Performance of the Lactate-to-Ionized Calcium Ratio for In-Hospital Mortality in Adult Major Trauma: A Retrospective Emergency Department Cohort Study.

Halil İbrahim Çimen, Mustafa Burak Sayhan, Eray Çeliktürk, Esin Seçgin Sayhan

Emergency Trauma CareCohort studyQ2IF 4.4

Lactate-to-ionized calcium ratio strongly predicts in-hospital death in major trauma

Prognostic Performance of the Lactate-to-Ionized Calcium Ratio for In-Hospital Mortality in Adult Major Trauma: A Retrospective Emergency Department Cohort Study.

Halil İbrahim Çimen … Esin Seçgin Sayhan

Diagnostics (Basel, Switzerland) · Jul 2026 · Q2 in General Medicine

Background

Early identification of adult major trauma patients at high risk of death remains challenging in the emergency department.

Purpose

This study evaluated the prognostic performance of the lactate-to-ionized calcium ratio (LiCa) for in-hospital mortality and compared it with established trauma scores.

Methods

This single-center retrospective cohort study included adults with major trauma, defined as an Injury Severity Score (Injury Severity Score) ≥ 16, who presented to a tertiary emergency department between May 2021 and April 2023.

n = 236 patients

Results

AUROC; 1.0 is perfect, higher LiCa strongly separates survivors from non-survivors

adjusted odds ratio 1.42 (95% CI 1.23 to 1.62)

null 1

1.23

1.62

CI excludes the null - significant

More results

In-hospital mortality occurred in 49 patients (20.8%).

LiCa remained associated with in-hospital mortality after adjustment (adjusted odds ratio, 1.42; 95% confidence interval, 1.23-1.62; p < 0.001).

More results

At an exploratory threshold of ≥12.59, LiCa yielded 82% sensitivity, 94% specificity, a positive likelihood ratio of 12.72, and a negative likelihood ratio of 0.20.

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Conclusion · 1 of 3

LiCa was independently associated with in-hospital mortality and showed good discrimination within this single-center retrospective cohort.

Conclusion · 2 of 3

As a rapidly available blood gas-derived measure, LiCa may provide exploratory adjunctive prognostic information at presentation, but it should not be interpreted as a replacement for validated trauma scoring systems.

Conclusion · 3 of 3

Prospective multicenter validation is needed before routine clinical use.

Prognostic Performance of the Lactate-to-Ionized Calcium Ratio for In-Hospital Mortality in Adult Major Trauma: A Retrospective Emergency Department Cohort Study.

Prognostic Performance of the Lactate-to-Ionized Calcium Ratio for In-Hospital Mortality in Adult Major Trauma: A Retrospective Emergency Department Cohort Study.

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