Department of Emergency Medicine, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir-Turkey.
Department of Biostatistics, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir-Turkey.
Ulus Travma Acil Cerrahi Derg. 2022 May;28(5):599-606. doi: 10.14744/tjtes.2021.02404.
Lactate and base deficit (BD) values are parameters evaluated as indicators of tissue perfusion and have been used as markers of severity of injury and mortality.
The aim of the study was to determine the relationship between combined score (CS) and blood transfusion need within 24 h and comparison of the variables between transfusion and non-transfusion group, correlation lactate with BD and with physiological, laboratory parameters, and determining the major risk factors of patients for the need for blood transfusion.
The study included a total of 359 patients (245 males, median age: 40, min-max: 18-95) with blunt multi-trauma. De-mographics data, laboratory parameters (hemoglobin [Hb], hematocrit [Htc], lactate, BD, pH), physiologic parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], respiratory rate [RR]), shock index (SI), and revised trauma score (RTS) were recorded. Logistic regression method was used to create the CS formula using lactate and BD values. According to this formula, the probability value of 0.092447509 was calculated for the need for blood transfusion within 24 h. If CS was higher than the probability value, the need for blood transfusion within 24 h was considered. Furthermore, univariate analysis was used to determine major risk for blood transfusion need in 24 h, and the receiver operating characteristic curves were performed to compare CS, lactate, BD, SI and RTS.
The comparison between transfusion and non-transfusion group there was significance between SBP, DBP, HR, RR, SpO2, Glasgow coma scale, Hb, Htc, lactate, BD, pH, SI and RTS (for each p<0.05). Lactate value has a positive correlation with SI, HR and has a negative correlation with BD, RTS, SBP, and DBP. BD values has a positive correlation with RTS, SBP, DBP, Hb, and Htc and has a negative correlation with SI, HR, and RR. The main risks for blood transfusion need were SI, lactate, BD, SBP, and SpO2%. CS was 0.09 in 100 (27.85%) patients and 41 with high CS had blood transfusion within 24 h (p<0.001; OR21.803, sensitivity 83.7%, specificity 81%,positive predictive value 41%, and negative predictive value 96.9%). A ROC curve showed that CS (AUC: 86.) was more significant than SI and RTS for the need for blood transfusion.
CS is effective for predicting blood necessity in 24 h for blunt multi-trauma patients.
乳酸和碱缺失（BD）值是作为组织灌注指标评估的参数，已被用作损伤严重程度和死亡率的标志物。
本研究旨在确定联合评分（CS）与 24 小时内输血需求之间的关系，并比较输血组和非输血组之间的变量，以及乳酸与 BD 以及与生理、实验室参数的相关性，确定患者需要输血的主要危险因素。
本研究共纳入 359 例（245 例男性，中位年龄：40 岁，最小-最大：18-95 岁）钝性多发伤患者。记录患者的人口统计学数据、实验室参数（血红蛋白[Hb]、血细胞比容[Htc]、乳酸、BD、pH 值）、生理参数（收缩压[SBP]、舒张压[DBP]、心率[HR]、呼吸频率[RR]）、休克指数（SI）和修订创伤评分（RTS）。使用乳酸和 BD 值，采用逻辑回归方法创建 CS 公式。根据该公式，计算出 24 小时内需要输血的概率值为 0.092447509。如果 CS 高于概率值，则认为 24 小时内需要输血。此外，采用单因素分析确定 24 小时内输血的主要危险因素，并绘制 CS、乳酸、BD、SI 和 RTS 的受试者工作特征曲线进行比较。
输血组和非输血组之间的比较，SBP、DBP、HR、RR、SpO2、格拉斯哥昏迷评分、Hb、Htc、乳酸、BD、pH 值、SI 和 RTS 之间存在显著差异（p<0.05）。乳酸值与 SI、HR 呈正相关，与 BD、RTS、SBP 和 DBP 呈负相关。BD 值与 RTS、SBP、DBP、Hb 和 Htc 呈正相关，与 SI、HR 和 RR 呈负相关。输血需求的主要危险因素是 SI、乳酸、BD、SBP 和 SpO2%。CS 在 100 例患者中为 0.09（27.85%），41 例高 CS 患者在 24 小时内输血（p<0.001；OR21.803，敏感性 83.7%，特异性 81%，阳性预测值 41%，阴性预测值 96.9%）。ROC 曲线显示 CS（AUC：86.）对于预测钝性多发伤患者 24 小时内输血需求比 SI 和 RTS 更有意义。
CS 可有效预测 24 小时内钝性多发伤患者的输血需求。
