Predictors for prognosis of adult patients with acute traumatic shock / 中华创伤杂志

ABSTRACT

Objective:To analyze the predictive factors for prognosis of adult patients with acute traumatic shock.Methods:A retrospective cohort study was used to analyze the clinical data of 122 adult patients with acute traumatic shock treated in ICU of Second People′s Hospital of Liaocheng from July 2013 to September 2021. There were 90 males and 32 females with the age range of 18-83 years [(49.8±16.9)years]. Injury severity score (ISS) was 14-50 points [(28.6±6.3)points]. According to the prognosis, the patients were divided into good prognosis group ( n=48) and poor prognosis group ( n=74). The gender, age, and leukocyte count, neutrophil count, lymphocyte count, platelet count, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), D-dimer, lactic acid, ISS and shock index (SI) on emergency admission were compared between the two groups. Univariate stepwise regression analysis and multivariate Logistic regression analysis were used to screen the indicators affecting the prognosis of patients with acute traumatic shock. Predictive value of the indicators affecting patients′ prognosis were analyzed by receiver operating characteristic (ROC) curve, and the area under the curve (AUC), sensitivity, specificity and optimal cut-off value were calculated. The indicators affecting the prognosis were analyzed by stratification analysis. Results:There was no significant difference between the two groups in gender, platelet count, D-dimer, ISS and SI (all P>0.05). The age, lymphocyte count and lactate level in poor prognosis group were higher than those in good prognosis group, while the leukocyte count, neutrophil count, NLR and PLR in poor prognosis group were lower than those in good prognosis group (all P<0.01). Univariate stepwise regression analysis showed that age and NLR were related to the prognosis of patients with acute traumatic shock (all P<0.01). While the gender, leukocyte count, neutrophil count, platelet count, PLR, D-dimer, lactic acid, ISS and SI had no correlation with the prognosis (all P>0.05). Multivariate Logistic regression analysis showed that age ( OR=0.96, 95% CI 0.93-0.98) and NLR ( OR=1.19, 95% CI 1.10-1.29) were the affecting factors for prognosis of patients with acute traumatic shock. ROC analysis showed the AUC of age for 0.32 (95% CI 0.22-0.41) together with the optimal cut-off value predicting prognosis for 48.5 years (sensitivity 68.9%, specificity 64.6%), the AUC of NLR for 0.79 (95% CI 0.71-0.90) together with the optimal cut-off value predicting prognosis for 6.51 (sensitivity 77.1%, specificity 71.6%). Stratified analysis showed that the proportion of patients in poor prognosis group was increased gradually with the increase of age ( P<0.01), while that was decreased significantly with the increase of NLR level ( P<0.01). Conclusions:Age and level of NLR on emergency admission can predict the prognosis of adult patients with acute traumatic shock, with the best cut-off value of 48.5 years and 0.79. Moreover, advanced age and lower level of NLR indicate much poorer prognosis.