Staziaki Pedro V, Qureshi Muhammad M, Maybury Aaron, Gangasani Neha R, LeBedis Christina A, Mercier Gustavo A, Anderson Stephan W
Department of Radiology, The University of Vermont Medical Center, Larner College of Medicine at the University of Vermont, Burlington, VT, United States.
Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.
Front Radiol. 2023 Sep 18;3:1186277. doi: 10.3389/fradi.2023.1186277. eCollection 2023.
Hematocrit and lactate have an established role in trauma as indicators of bleeding and cell death, respectively. The wide availability of CT imaging and clinical data poses the question of how these can be used in combination to predict outcomes.
To assess the utility of hematocrit or lactate trends in predicting intensive care unit (ICU) admission and hospital length of stay (LOS) in patients with torso trauma combined with clinical parameters and injury findings on CT.
This was a single-center retrospective study of adults with torso trauma in one year. Trends were defined as a unit change per hour. CT findings and clinical parameters were explanatory variables. Outcomes were ICU admission and hospital LOS. Multivariate logistic and negative binomial regression models were used to calculate the odds ratio (OR) and incident rate ratio (IRR).
Among 840 patients, 561 (72% males, age 39 ± 18) were included, and 168 patients (30%) were admitted to the ICU. Decreasing hematocrit trend [OR 2.54 (1.41-4.58), = 0.002] and increasing lactate trend [OR 3.85 (1.35-11.01), = 0.012] were associated with increased odds of ICU admission. LOS median was 2 (IQR: 1-5) days. Decreasing hematocrit trend [IRR 1.37 (1.13-1.66), = 0.002] and increasing lactate trend [2.02 (1.43-2.85), < 0.001] were associated with longer hospital LOS.
Hematocrit and lactate trends may be helpful in predicting ICU admission and LOS in torso trauma independent of organ injuries on CT, age, or admission clinical parameters.
血细胞比容和乳酸盐在创伤中分别作为出血和细胞死亡的指标，其作用已得到确立。CT成像和临床数据的广泛可得性引发了一个问题，即如何将这些数据结合起来用于预测预后。
评估血细胞比容或乳酸盐趋势联合临床参数及CT上的损伤表现，对躯干创伤患者入住重症监护病房（ICU）及住院时间（LOS）的预测效用。
这是一项对一年内成年躯干创伤患者的单中心回顾性研究。趋势定义为每小时的单位变化。CT检查结果和临床参数为解释变量。结局指标为入住ICU和住院LOS。采用多因素逻辑回归和负二项回归模型计算比值比（OR）和发病率比（IRR）。
840例患者中，纳入561例（72%为男性，年龄39±18岁），168例（30%）入住ICU。血细胞比容下降趋势[OR 2.54（1.41 - 4.58），P = 0.002]和乳酸盐上升趋势[OR 3.85（1.35 - 11.01），P = 0.012]与入住ICU的几率增加相关。LOS中位数为2（四分位间距：1 - 5）天。血细胞比容下降趋势[IRR 1.37（1.13 - 1.66），P = 0.002]和乳酸盐上升趋势[2.02（1.43 - 2.85），P < 0.001]与更长的住院LOS相关。
血细胞比容和乳酸盐趋势可能有助于预测躯干创伤患者入住ICU及LOS，且独立于CT上的器官损伤、年龄或入院临床参数。
