Şentürk Güldehen Özmen, Ünlüer Erden Erol, Vandenberk Nergiz, Yavaşi Özcan, Eroglu Orhan, Sürüm Nebi, Üstüner Füsün, Kayayurt Kamil
Department of Emergency Medicine, Izmir Ataturk Research and Training Hospital, Izmir, Turkey.
J Emerg Med. 2013 Jun;44(6):1070-6. doi: 10.1016/j.jemermed.2012.11.037. Epub 2013 Feb 8.
Many scoring systems have been developed to predict the prognosis of the traumatized patients in Emergency Departments, and the necessary calculations make complex scoring systems difficult to use as a part of the initial trauma patient assessment, and they also have limited accuracy.
This study compares the accuracy of cystatin C with trauma scoring systems in predicting the mortality of trauma patients.
Serum cystatin C levels were measured upon arrival in consecutive adult multiple blunt trauma patients during a 12-month period. Correlation analysis was used to assess the relationship between Injury Severity Score (ISS), Revised Trauma Score (RTS), Glasgow Coma Scale (GCS) Score, and cystatin C. Trauma scores and cystatin C were used in Cox regression models to predict trauma patients' risk of death.
During the study period, 153 patients were enrolled and 18 died. There were negative correlations between cystatin C levels and the GCS (r = -0.666, p < 0.001) as well as the RTS (r = -0.229, p = 0.004). A moderate correlation was found between the ISS and the cystatin C level (r = 0.492, p < 0.001). In Cox regression models, every increase in units of cystatin C levels and ISS (the cut-off levels were 0.93 mg/L and ≥ 16, respectively) results in a 4.22- and 1.068-fold increase in mortality, respectively.
Cystatin C may represent an important severity-of-illness indicator, easily available to clinicians during the initial assessment of trauma victims on admission.
已经开发了许多评分系统来预测急诊科创伤患者的预后，而必要的计算使得复杂的评分系统难以作为初始创伤患者评估的一部分使用，并且它们的准确性也有限。
本研究比较胱抑素C与创伤评分系统在预测创伤患者死亡率方面的准确性。
在12个月期间，对连续收治的成年多发性钝性创伤患者入院时测定血清胱抑素C水平。采用相关性分析评估损伤严重程度评分（ISS）、修订创伤评分（RTS）、格拉斯哥昏迷量表（GCS）评分与胱抑素C之间的关系。将创伤评分和胱抑素C用于Cox回归模型，以预测创伤患者的死亡风险。
在研究期间，共纳入153例患者，其中18例死亡。胱抑素C水平与GCS（r = -0.666，p < 0.001）以及RTS（r = -0.229，p = 0.004）之间呈负相关。ISS与胱抑素C水平之间存在中度相关性（r = 0.492，p < 0.001）。在Cox回归模型中，胱抑素C水平和ISS每增加一个单位（截断水平分别为0.93 mg/L和≥16），死亡率分别增加4.22倍和1.068倍。
胱抑素C可能是一种重要的疾病严重程度指标，临床医生在创伤受害者入院初始评估时易于获得。
