Hwabejire John O, Nembhard Christine E, Oyetunji Tolulope A, Seyoum Theodros, Abiodun Mayowa P, Siram Suryanarayana M, Cornwell Edward E, Greene Wendy R
Department of Surgery, Howard University College of Medicine and Howard University Hospital, Washington, District of Columbia.
Department of Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
J Surg Res. 2017 Jun 1;213:199-206. doi: 10.1016/j.jss.2015.04.056. Epub 2015 Apr 23.
There are sparse data on the association between age and mortality in hemorrhagic shock (HS). We examined this association in this study.
The Glue Grant database was analyzed. Patients aged ≥16 y with blunt traumatic HS were stratified into eight age groups (16-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, and ≥85 y) to identify the mortality inflection point. Subsequently, patients were restratified into young age (16-44 y), middle age (45-64 y), and elderly (≥65 y). Multivariate analysis was used to determine predictors of mortality by group.
A total of 1976 patients were included, with mortality of 16%. Mortality by initial age group is as follows: 16-24 (13.0%), 25-34 (11.9%), 35-44 (11.9%), 45-54 (15.6%), 55-64 (15.7%), 65-74 (20.3%), 75-84 (38.2%), and ≥85 y (51.6%), delineating 65 y as the mortality inflection point. Overall, 55% were young, 30% middle age, and 15% elderly. Predictors of mortality in the young include multiple-organ dysfunction score (MODS; odds ratio [OR]: 1.93, confidence interval [CI]: 1.62-2.30), emergency room lactate (OR: 1.14, CI: 1.02-1.27), injury severity score (OR: 1.06, CI: 1.03-1.09), and cardiac arrest (OR: 10.60, CI: 3.05-36.86). Predictors of mortality in the middle age include MODS (OR: 1.38, CI: 1.24-1.53), cardiac arrest (OR: 12.24, CI: 5.38-27.81), craniotomy (OR: 5.62, CI: 1.93-16.37), and thoracotomy (OR: 2.76, CI: 1.28-5.98). In the elderly, predictors of mortality were age (OR: 1.07, CI: 1.02-1.13), MODS (OR: 1.47, CI: 1.26-1.72), laparotomy (OR: 2.04, CI: 1.02-4.08), and cardiac arrest (OR: 11.61, CI: 4.35-30.98). Open fixation of nonfemoral fractures was protective against mortality in all age groups.
In blunt HS, mortality parallels increasing age, with the inflection point at 65 y. MODS and cardiac arrest uniformly predict mortality across all age groups. Craniotomy and thoracotomy are associated with mortality in the middle age, whereas laparotomy is associated with mortality in the elderly.
关于出血性休克（HS）患者年龄与死亡率之间的关联，相关数据较少。我们在本研究中对这种关联进行了调查。
分析Glue Grant数据库。将年龄≥16岁的钝性创伤性HS患者分为8个年龄组（16 - 24岁、25 - 34岁、35 - 44岁、45 - 54岁、55 - 64岁、65 - 74岁、75 - 84岁和≥85岁），以确定死亡率拐点。随后，将患者重新分为青年组（16 - 44岁）、中年组（45 - 64岁）和老年组（≥65岁）。采用多因素分析确定各年龄组的死亡预测因素。
共纳入1976例患者，死亡率为16%。各初始年龄组的死亡率如下：16 - 24岁（13.0%）、25 - 34岁（11.9%）、35 - 44岁（11.9%）、45 - 54岁（15.6%）、55 - 64岁（15.7%）、65 - 74岁（20.3%）、75 - 84岁（38.2%）和≥85岁（51.6%），确定65岁为死亡率拐点。总体而言，青年组占55%，中年组占30%，老年组占15%。青年组的死亡预测因素包括多器官功能障碍评分（MODS；比值比[OR]：1.93，置信区间[CI]：1.62 - 2.30）、急诊室乳酸水平（OR：1.14，CI：1.02 - 1.27）、损伤严重程度评分（OR：1.06，CI：1.03 - 1.09）和心脏骤停（OR：10.60，CI：3.05 - 36.86）。中年组的死亡预测因素包括MODS（OR：1.38，CI：1.24 - 1.53）、心脏骤停（OR：12.24，CI：5.38 - 27.81）、开颅手术（OR：5.62，CI：1.93 - 16.37）和开胸手术（OR：2.76，CI：1.28 - 5.98）。老年组的死亡预测因素为年龄（OR：1.07，CI：1.02 - 1.13）、MODS（OR：1.47，CI：1.26 - 1.72）、剖腹手术（OR：2.04，CI：1.02 - 4.08）和心脏骤停（OR：11.61，CI：4.35 - 30.98）。非股骨骨折的切开复位内固定术对所有年龄组的死亡率均有保护作用。
在钝性HS中，死亡率随年龄增长而升高，拐点为65岁。MODS和心脏骤停在所有年龄组中均为死亡的一致预测因素。开颅手术和开胸手术与中年组死亡率相关，而剖腹手术与老年组死亡率相关。
