Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea.
Department of Emergency Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea.
Injury. 2021 May;52(5):1151-1157. doi: 10.1016/j.injury.2021.03.001. Epub 2021 Mar 4.
This study aimed to investigate the ion shift index (ISI) as a prognostic factor of severe trauma. We hypothesized that the initial ISI measured in the emergency department (ED) is associated with discharge survival in severe non-isolated head injury (IHI) patients.
This retrospective observational study included severe trauma patients with available medical records from January 2017 to December 2018 but excluded those with IHI. Logistic regression analysis was conducted to identify the risk factors for mortality in non-IHI patients, and adjustments were performed for relevant covariates. An area under the receiver operating characteristics curve (AUROC) analysis was performed to examine the primary outcome of our study, which was mortality at hospital discharge in severe non-IHI trauma patients.
Of the 483 severe non-IHI trauma patients included in the study, 86 patients (17.8 %) died. The multiple logistic regression analysis demonstrated ISI (odds ratio [OR], 2.300; 95% CI, 1.183-4.470) was significantly associated with mortality in the non-IHI group. Additionally, trauma and injury severity score (TRISS; OR, 0.538; 95% CI, 0.447-0.649), lactate (OR, 1.410; 95% CI, 1.252-1.588), creatinine (OR, 1.554; 95% CI, 1.221-1.979), and activated partial thromboplastin time (aPTT; OR, 1.050; 95% CI, 1.021-1.080) were independently associated with mortality at hospital discharge. The AUROC values for TRISS, lactate, aPTT, creatinine, and ISI were as follows: 0.892 (95% CI, 0.861-0.918), 0.838 (95% CI, 0.803-0.870), 0.754 (95% CI, 0.712-0.792), 0.650 (95% CI, 0.606-0.693), and 0.848 (95% CI, 0.813-0.879), respectively. The AUROC for the multiple logistic regression model with ISI was 0.942 (95% CI, 0.917-0.962). In a model in which TRISS was omitted, the addition of ISI to other predictors significantly improved the AUROC to 0.900 (95% CI, 0.869-0.925) (p=0.039).
The initial ISI in the ED after trauma was associated with mortality in severe non-IHI trauma patients. In conjunction with other prognostic indicators, it could be used as an early prognostic marker, particularly if TRISS is unavailable.
本研究旨在探讨离子移位指数（ISI）作为严重创伤患者的预后因素。我们假设，在急诊科（ED）测量的初始 ISI 与严重非孤立性颅脑损伤（IHI）患者的出院生存率有关。
本回顾性观察性研究纳入了 2017 年 1 月至 2018 年 12 月期间有病历记录的严重创伤患者，但排除了 IHI 患者。使用逻辑回归分析确定非 IHI 患者死亡的危险因素，并对相关协变量进行调整。通过受试者工作特征曲线（ROC）下面积（AUROC）分析评估我们研究的主要结局，即严重非 IHI 创伤患者出院时的死亡率。
在纳入的 483 例严重非 IHI 创伤患者中，有 86 例（17.8%）患者死亡。多因素逻辑回归分析显示，ISI（比值比[OR]，2.300；95%置信区间[CI]，1.183-4.470）与非 IHI 组的死亡率显著相关。此外，创伤和损伤严重程度评分（TRISS；OR，0.538；95%CI，0.447-0.649）、乳酸（OR，1.410；95%CI，1.252-1.588）、肌酐（OR，1.554；95%CI，1.221-1.979）和活化部分凝血活酶时间（aPTT；OR，1.050；95%CI，1.021-1.080）与出院时的死亡率独立相关。TRISS、乳酸、aPTT、肌酐和 ISI 的 AUROC 值分别为：0.892（95%CI，0.861-0.918）、0.838（95%CI，0.803-0.870）、0.754（95%CI，0.712-0.792）、0.650（95%CI，0.606-0.693）和 0.848（95%CI，0.813-0.879）。ISI 多因素逻辑回归模型的 AUROC 为 0.942（95%CI，0.917-0.962）。在排除 TRISS 的模型中，将 ISI 添加到其他预测因子中可显著提高 AUROC 至 0.900（95%CI，0.869-0.925）（p=0.039）。
创伤后急诊科的初始 ISI 与严重非 IHI 创伤患者的死亡率相关。与其他预后指标结合使用，它可以作为早期预后标志物，尤其是在无法获得 TRISS 时。
