ABSTRACT
Objective To investigate the value of emergency physician-led focused assessment with sonography for trauma(FAST)combined with serum C-reactive protein(CRP),procalcitonin(PCT),and interleukin-6(IL-6)testing in predicting the clinical outcome of patients with acute chest and abdominal trauma.Methods Ninety-six patients with acute thoracoabdominal trauma,who had been admitted to the Department of Emergency in our hospital from February 2019 to February 2022,were selected for this study.The patients were grouped according to their clinical outcomes,with the individuals who died after 48 h of treatment classified to the death group(n = 14)and all the others to the survival group(n = 82).The general clinical indicators(sex,age,body mass,trauma type,smoking history,alcohol consumption history,and previous chest and abdominal surgery history),CRAMS scores,inferior vena cava-collapse index(IVC-CI),and serum CRP,PCT,and IL-6 levels at 0,24,and 48 h after admission were compared between the two groups.Logistic regression analysis was used to identify the factors that influence the outcomes of patients with acute thoracoabdominal trauma based on statistically significant differences(P＜0.05)between the two groups.Receiver operating characteristic(ROC)curves of the IVC-CI combined with serum CRP,PCT,and IL-6 detection were plotted to evaluate the value in predicting clinical outcomes.Results The serum CRP,PCT,and IL-6 levels,CRAMS score,and IVC-CI in the death group were higher than those in the survival group at 0,24,and 48 h after admis-sion(all P＜0.001).The serum CRP,PCT,and IL-6 levels in patients in the death group gradually increased from 0,24,and 48 h after admission,and the differences between each time point were statistically significant(all P＜0.05).In the patients in the survival group,these serum protein levels increased from 0 to 24 h after admission and peaked at 48 h,and the differences between each time point were statistically significant(all P＜0.05).The logistic regression analysis showed that the CRAMS score,IVC-CI,and serum CRP,PCT,and IL-6 levels were risk factors affecting the outcome of patients with acute chest and abdominal trauma(all P＜0.05).The area under the ROC curve for the IVC-CI combined with serum CRP,PCT,and IL-6 detection was greater than that for each individual assessment type alone(all P＜0.05),and the use of the IVC-CI combined with serum CRP,PCT,and IL-6 detection to predict the clinical outcome of patients with acute chest and abdominal trauma had net clinical benefit.Conclusion The IVC-CI and serum CRP,PCT,and IL-6 levels were associ-ated with the clinical outcomes of patients with acute thoracoabdominal trauma.Therefore,emergency physician-led bedside ultrasound FAST combined with 48 h serum CRP,PCT,and IL-6 testing has good value for predicting the clinical outcomes of patients with acute chest and abdominal trauma.
ABSTRACT
Objective To investigate the value of serum and biliary carcinoembryonic antigen (CEA),carbohydrate antigen 19-9 (CA19 -9),and carbohydrate antigen 24-2 (CA24-2) in the diagnosis of benign and malignant biliary obstructive diseases.Methods A total of 40 patients with benign biliary obstructive diseases and 40 with malignant ones,who were diagnosed and treated in The Central Hospital of Enshi Autonomous Prefecture from June 2015 to December 2016,were enrolled.Serum samples collected on admission and bile samples collected during surgery were used to measure the levels of tumor markers CEA,CA19-9,and CA24-2.The t-test was used for comparison between two groups,and a receiver operating characteristic (ROC) curve analysis was performed for each tumor marker in the diagnosis of benign and malignant biliary obstructive diseases.Results Compared with the benign group,the malignant group had significantly higher serum levels of CA19-9 and CA24-2 (t =5.899 and 3.223,both P ＜ 0.05) and biliary levels of CEA,CA19-9,and CA24-2 (t =3.304,7.615,and 7.279,all P ＜0.05).In the patients with malignant biliary obstructive diseases,the levels of CEA,CA19-9,and CA24-2 in the bile were significantly higher than those in serum (t =3.297,4.975,and 3.993,all P ＜ 0.05).Biliary CA24-2 had the highest Youden index (0.75) and area under the ROC curve (AUC) (0.946);biliary CA19-9 had a Youden index of 0.74 and an AUC of 0.937,and serum CA19-9 had a Youden index of 0.68 and an AUC of 0.898.These three indices had a relatively high diagnostic value.Combined measurement of biliary CA24-2,serum CA19-9,and biliary CA19-9 had a sensitivity of 94.75％,a negative predictive value of 93.50％,and a Youden index of 0.82 in the diagnosis of malignant biliary obstructive diseases.Conclusion Biliary tumor markers have a great value in the diagnosis of malignant biliary obstructive diseases,and the combined measurement of biliary CA24-2,serum CA19-9,and biliary CA19-9 has the highest value in the differential diagnosis of benign and malignant biliary obstructive diseases.