Jang Ha Nee, Park Hyun Oh, Yang Tae Won, Yang Jun Ho, Kim Sung Hwan, Moon Seong Ho, Byun Joung Hun, Lee Chung Eun, Kim Jong Woo, Kang Dong Hun, Baek Kyeong Hee
Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Jinju, Korea.
Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Changwon, Korea.
Korean J Crit Care Med. 2017 Aug;32(3):240-246. doi: 10.4266/kjccm.2017.00360. Epub 2017 Aug 31.
Initial evaluation of injury severity in trauma patients is an important and challenging task. We aimed to assess whether easily measurable biochemical parameters (hemoglobin, pH, and prothrombin time/international normalized ratio [PT/INR]) can predict in-hospital mortality in patients with severe trauma.
This retrospective study involved review of the medical records of 315 patients with severe trauma and an injury severity score >15 who were managed at Gyeongsang National University Hospital between January 2005 and December 2015. We extracted the following data: in-hospital mortality, injury severity score, and initial hemoglobin level, pH, and PT/INR. The predictive values of these variables were compared using receiver operation characteristic curves.
Of the 315 patients, 72 (22.9%) died. The in-hospital mortality rates of patients with hemoglobin levels <8.4 g/dl and ≥8.4 g/dl were 49.8% and 9.9%, respectively (P < 0.001). At a cutoff hemoglobin level of 8.4 g/dl, the sensitivity and specificity values for mortality were 81.9% and 86.4%, respectively. At a pH cutoff of 7.25, the sensitivity and specificity values for mortality were 66.7% and 77.8%, respectively; 66.7% of patients with a pH <7.25 died versus 22.2% with a pH ≥7.25 (P < 0.001). The in-hospital mortality rates for patients with PT/INR values ≥1.4 and <1.4 were 37.5% and 16%, respectively (P < 0.001; sensitivity, 37.5%; specificity, 84%).
Using the suggested cutoff values, hemoglobin level, pH, and PT/INR can simply and easily be used to predict in-hospital mortality in patients with severe trauma.
创伤患者损伤严重程度的初始评估是一项重要且具有挑战性的任务。我们旨在评估易于测量的生化参数（血红蛋白、pH值和凝血酶原时间/国际标准化比值[PT/INR]）是否能够预测严重创伤患者的院内死亡率。
这项回顾性研究涉及对2005年1月至2015年12月期间在庆尚国立大学医院接受治疗的315例严重创伤且损伤严重程度评分>15的患者的病历进行回顾。我们提取了以下数据：院内死亡率、损伤严重程度评分以及初始血红蛋白水平、pH值和PT/INR。使用受试者工作特征曲线比较这些变量的预测价值。
315例患者中，72例（22.9%）死亡。血红蛋白水平<8.4 g/dl和≥8.4 g/dl的患者院内死亡率分别为49.8%和9.9%（P<0.001）。在血红蛋白水平临界值为8.4 g/dl时，死亡率的敏感性和特异性值分别为81.9%和86.4%。在pH临界值为7.25时，死亡率的敏感性和特异性值分别为66.7%和77.8%；pH<7.25的患者中有66.7%死亡，而pH≥7.25的患者中有22.2%死亡（P<0.001）。PT/INR值≥1.4和<1.4的患者院内死亡率分别为37.5%和16%（P<0.001；敏感性为37.5%；特异性为84%）。
使用建议的临界值，血红蛋白水平、pH值和PT/INR可简单且容易地用于预测严重创伤患者的院内死亡率。
