Department of Emergency Medicine, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul-Türkiye.
Department of Emergency Medicine, Yenimahalle Training and Research Hospital, Ankara-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2024 Oct;30(10):737-744. doi: 10.14744/tjtes.2024.15003.
Thoracic trauma is a significant cause of mortality, especially among those arriving at hospitals. This study explores the associations between mortality, the shock index (SI), and specific metabolic and biochemical markers in patients with isolated thoracic trauma.
This retrospective cross-sectional study included all consecutive adult patients presenting with isolated thoracic trauma to a high-volume emergency department from January 2019 to December 2023. The predictive capability of SI levels and selected biomarkers upon admission for estimating mortality was assessed by determining the areas under the receiver operating characteristic curves (AUCs). Optimal cutoff values were determined using the Youden index method.
The study involved 352 patients, with 285 (81%) being males and an average age of 50.0±17.7 years. The mortality rate was 9.6%. Mortality was significantly associated with higher shock index (odds ratio [OR]: 14.02, [95% confidence interval [CI] 0.847-0.916], AUC=0.885, p=0.001), glucose/potassium ratio (OR: 1.24 [95% CI 1.14-1.35], AUC=0.869, p<0.001), and lactate levels (OR: 4.30 [95% CI 2.29-8.07], AUC=0.832, p<0.001). The optimal cutoff values determined for the shock index, glucose/potassium ratio, ionized calcium, and lactate were 1.02 (sensitivity, 94.1%; specificity 69.5%; positive predictive value [PPV], 24.8; negative predictive value [NPV], 99.1), 36.85 (sensitivity, 76.5%; specificity, 87.7%; PPV, 40.0; NPV, 97.2), 1.23 (sensitivity, 94.1%; specificity, 56.0%; PPV, 18.6; NPV, 98.9), and 1.98 (sensitivity, 70.6%; specificity, 80.5%; PPV, 27.9; NPV, 96.2), respectively.
This study demonstrates that higher shock index, glucose/potassium ratio, and lactate levels are significantly associated with increased mortality in patients with isolated thoracic trauma. These findings suggest that these markers can be effective prognostic indicators, potentially guiding clinical decision-making and improving patient outcomes.
胸部创伤是导致死亡的一个重要原因，尤其是在到达医院的患者中。本研究旨在探讨孤立性胸部创伤患者的死亡率、休克指数（SI）与特定代谢和生化标志物之间的关联。
这是一项回顾性的、横断面的研究，纳入了 2019 年 1 月至 2023 年 12 月期间在一家高容量急诊科就诊的所有连续的成年孤立性胸部创伤患者。通过确定受试者工作特征曲线（ROC）下的面积（AUC），评估入院时 SI 水平和选定生物标志物对死亡率的预测能力。使用约登指数法确定最佳截断值。
该研究共纳入 352 例患者，其中 285 例（81%）为男性，平均年龄为 50.0±17.7 岁。死亡率为 9.6%。死亡率与较高的休克指数（优势比[OR]：14.02，[95%置信区间[CI]0.847-0.916]，AUC=0.885，p=0.001）、血糖/钾比值（OR：1.24[95%CI 1.14-1.35]，AUC=0.869，p<0.001）和乳酸水平（OR：4.30[95%CI 2.29-8.07]，AUC=0.832，p<0.001）显著相关。确定的休克指数、血糖/钾比值、离子钙和乳酸的最佳截断值分别为 1.02（灵敏度 94.1%；特异性 69.5%；阳性预测值[PPV]24.8；阴性预测值[NPV]99.1）、36.85（灵敏度 76.5%；特异性 87.7%；PPV 40.0；NPV 97.2）、1.23（灵敏度 94.1%；特异性 56.0%；PPV 18.6；NPV 98.9）和 1.98（灵敏度 70.6%；特异性 80.5%；PPV 27.9；NPV 96.2）。
本研究表明，较高的休克指数、血糖/钾比值和乳酸水平与孤立性胸部创伤患者的死亡率增加显著相关。这些发现表明，这些标志物可以作为有效的预后指标，有可能指导临床决策并改善患者预后。
Zotero 插件