Construction and evaluation of models for early diagnosis and prognosis assessment of trauma sepsis risks / 中华创伤杂志

ABSTRACT

Objective To investigate the value of muhiple inflammatory cells and clinical score in early diagnosis and prognosis assessment of trauma sepsis risks.Methods This retrospective control study enrolled 209 severe trauma patients admitted from January 2010 and May 2016.White blood cell count,lymphocyte count and percentage,monocyte count and percentage,neutrophil count and percentage,ratio of neutrophil to lymphocyte count (N/L),acute physiology and chronic health evaluation (APACHE) Ⅱ score,sequential organ failure assessment (SOFA),improved early warning score (MEWS),Glasgow coma score (GCS),multiple organ dysfunction syndrome (MODS) score and lactic acid (LAC) were collected on the day of admission and 3,5,7 days after trauma.These data were applied to construct weighted and biological score models for early diagnosis and prognosis of traumatic sepsis.Receiver operating characteristic curve (ROC) was performed and area under the curve (AUC) was calculated to measure the value of the two models in early diagnosis and prognosis of sepsis.Results AUC of the weighted model combined by APACHE Ⅱ score,SOFA score and MEWS was 0.729 on the day of admission.AUC of the weighted model combined by inflammatory cells was 0.680 and AUC of the biological score model was 0.800 3 days after trauma (P ＜ 0.05).AUC of the weighted models combined by inflammatory cells was 0.798 and AUC of the biological score model was 0.812 5 days after trauma (P ＜ 0.05).AUC of the weighted models combined by inflammatory cells was 0.706 and AUC of the biological score model was 0.713 7 days after trauma (P ＞ 0.05).AUC of the biological score model had significant difference 3 days and 5 days after trauma (P ＜ 0.05).Of the weighted model combined by APACHE Ⅱ score,MODS score,GCS and LAC to evaluate the prognosis of sepsis,the AUC showed significant difference on the day of admission (0.838),3 days after trauma (0.878),5 days after trauma (0.947) and 7 days after trauma (0.936) (P ＜ 0.05).Conclusions Biological score possesses better effect on early diagnosis of sepsis 3 days after trauma.Weighted model combined by APACHE Ⅱ score,MODS score,GCS and LAC can effectively predict the prognosis of sepsis 5 days after trauma.