Lee Dong Hun, Lee Byung Kook, Jeung Kyung Woon, Park Jung Soo, Lim Yong Deok, Jung Yong Hun, Lee Sung Min, Cho Yong Soo
Department of Emergency Medicine, Chonnam National University Hospital, Donggu, Gwangju Department of Emergency Medicine, Chungnam National University, Daejeon Department of Emergency Medical Services, Kongju National University, Kongju, Republic of Korea.
Medicine (Baltimore). 2018 Aug;97(33):e11912. doi: 10.1097/MD.0000000000011912.
The present study aimed to analyze and compare the prognostic performances of the Japanese Ministry of Health and Welfare (JMHW) score, the Korean Society on Thrombosis and Hemostasis (KSTH) score, the International Society on Thrombosis and Haemostasis (ISTH) score, the Japanese Association for Acute Medicine (JAAM) score, and the revised JAAM (rJAAM) score, for 28-day mortality in severe trauma.This retrospective observational study included patients admitted for severe trauma between 2012 and 2015. Receiver operating characteristics analysis was performed to examine the prognostic performance of the 5 different DIC score systems. The primary outcome was 28-day mortality following an injury.Of the 1266 patients included in the study, 28-day mortality rate was 19.7% (n = 249). The area under the curves (AUCs) of JMHW, KSTH, ISTH, JAAM, and rJAAM scores for 28-day mortality were 0.751 [95% confidence interval (95% CI), 0.726-0.775], 0.726 (95% CI, 0.701-0.750), 0.700 (95% CI, 0.674-0.725), 0.673 (95% CI, 0.646-0.699), and 0.676 (95% CI, 0.649-0.701), respectively. The AUC of JMHW score was significantly different from those of the other score systems. Fibrinogen levels ≤1.0 g/L [odds ratio (OR), 1.824; 95% CI, 1.029-3.232] and 1.0 to 1.5 g/L (OR, 1.697; 95% CI, 1.058-2.724) were independently associated with 28-day mortality compared with fibrinogen level above 1.5 g/L.JMHW score has the highest prognostic performance for 28-day mortality among DIC score systems in severe trauma. Fibrinogen level seemed to have a role in greater discrimination of JMHW scores than the other DIC score systems.
本研究旨在分析和比较日本厚生省（JMHW）评分、韩国血栓与止血学会（KSTH）评分、国际血栓与止血学会（ISTH）评分、日本急性医学协会（JAAM）评分以及修订后的JAAM（rJAAM）评分对严重创伤患者28天死亡率的预测性能。这项回顾性观察性研究纳入了2012年至2015年间因严重创伤入院的患者。进行了受试者工作特征分析，以检验5种不同弥散性血管内凝血（DIC）评分系统的预测性能。主要结局是受伤后28天死亡率。
在纳入研究的1266例患者中，28天死亡率为19.7%（n = 249）。JMHW、KSTH、ISTH、JAAM和rJAAM评分对28天死亡率的曲线下面积（AUC）分别为0.751[95%置信区间（95%CI），0.726 - 0.775]、0.726（95%CI，0.701 - 0.750）、0.700（95%CI，0.674 - 0.725）、0.673（95%CI，0.646 - 0.699）和0.676（95%CI，0.649 - 0.701）。JMHW评分的AUC与其他评分系统的AUC有显著差异。与纤维蛋白原水平高于1.5 g/L相比，纤维蛋白原水平≤1.0 g/L[比值比（OR），1.824；95%CI，1.029 - 3.232]和1.0至1.5 g/L（OR，1.697；95%CI，1.058 - 2.724）与28天死亡率独立相关。
在严重创伤的DIC评分系统中，JMHW评分对28天死亡率具有最高的预测性能。与其他DIC评分系统相比，纤维蛋白原水平似乎在JMHW评分的鉴别能力方面发挥了更大作用。
