初始多发伤CT成像定义的下腔静脉容积的预后意义：一级创伤中心的单中心经验
Prognostic significance of inferior vena cava volume defined by initial polytrauma CT-imaging: single-center experience of a level-1 trauma center.
作者信息
Meyer Hans-Jonas, Sotikova Veronika, Hetz Michael, Osterhoff Georg, Kleber Christian, Denecke Timm, Werdehausen Robert, Hempel Gunther, Struck Manuel F
机构信息
Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr.20, 04103, Leipzig, Germany.
Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
出版信息
Int J Emerg Med. 2024 Oct 21;17(1):160. doi: 10.1186/s12245-024-00752-9.
BACKGROUND
The significance of computed tomography (CT)-based volume measurement of the inferior vena cava (IVC) in the treatment and prognosis of trauma patients is not yet fully understood. The conflicting results that have been reported may be attributable to differences in injury severity and the use of different measurement methods, including IVC index and volumetry. The purpose of this study was to determine the relationship between IVC volume and red blood cell (RBC) transfusion and mortality in intubated trauma patients who were stable enough for initial CT imaging.
METHODS
A retrospective analysis was conducted on all consecutive trauma patients who underwent emergency tracheal intubation and mechanical ventilation before initial whole-body CT imaging at a level-1 trauma center over a 12-year period (2008-2019). The IVC volume was determined on initial trauma CT and included in multivariable models with demographic and diagnostic data. Associations of overall RBC transfusion, massive transfusion, 24-h mortality, and 30-day mortality were assessed using logistic regression analyses and Cox proportional hazard models.
RESULTS
A total of 438 patients (75.3% male) with a median age of 50 years, and a median injury severity score (ISS) of 26 points were included in the analysis. Most of the patients (97.5%) had suffered from blunt trauma mechanisms. Median IVC volume was 36.25 cm, and RBC transfusion and massive transfusion were performed in 197 and 90 patients, respectively. The 24-h and 30-day mortality rates were 7.3% and 23.3%, respectively. VCI volume was found to be independently associated with the necessity of RBC transfusion and 24-h mortality (OR 0.98, 95% CI 0.96-0.99, p = 0.01 and HR 0.96, 95% CI 0.93-0.99, p = 0.025, respectively), while associations with massive transfusion and 30-day mortality were not statistically significant in multivariable analyses.
CONCLUSION
Initial IVC volume may serve as a predictor of patients at risk for overall RBC transfusion requirements and 24-h mortality, suggesting the possibility of its diagnostic efficacy in short-term outcomes. Further studies are needed to confirm these findings.
背景
基于计算机断层扫描（CT）测量下腔静脉（IVC）容积在创伤患者治疗和预后中的意义尚未完全明确。已报道的相互矛盾的结果可能归因于损伤严重程度的差异以及不同测量方法的使用，包括IVC指数和容积测量。本研究的目的是确定在病情稳定到足以进行初始CT成像的插管创伤患者中，IVC容积与红细胞（RBC）输注及死亡率之间的关系。
方法
对一家一级创伤中心在12年期间（2008 - 2019年）所有在初始全身CT成像前接受紧急气管插管和机械通气的连续创伤患者进行回顾性分析。在初始创伤CT上确定IVC容积，并将其纳入包含人口统计学和诊断数据的多变量模型中。使用逻辑回归分析和Cox比例风险模型评估总体RBC输注、大量输血、24小时死亡率和30天死亡率之间的关联。
结果
共有438例患者（75.3%为男性）纳入分析，中位年龄50岁，中位损伤严重程度评分（ISS）为26分。大多数患者（97.5%）为钝性创伤机制。IVC容积中位数为36.25 cm，分别有197例和90例患者接受了RBC输注和大量输血。24小时和30天死亡率分别为7.3%和23.3%。发现IVC容积与RBC输注的必要性和24小时死亡率独立相关（OR分别为0.98，95%CI为0.96 - 0.99，p = 0.01；HR为0.96，95%CI为0.93 - 0.99，p = 0.025），而在多变量分析中与大量输血和30天死亡率的关联无统计学意义。
结论
初始IVC容积可作为总体RBC输注需求风险和24小时死亡率患者的预测指标，提示其在短期预后中具有诊断效能的可能性。需要进一步研究来证实这些发现。
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