Kang Yangbo, Yang Qi, Ding Hongbo, Hu Yufeng, Shen Jiasheng, Ruan Feng, Chen Bojin, Feng Yiping, Jin Yuchen, Xu Shanxiang, Jiang Libing, Wang Guirong, Xu Yong'an
Department of Emergency Medicine, the Second Affiliated Hospital Zhejiang University School of Medicine / Institute of Emergency Medicine of Zhejiang University, Hangzhou 310009, China.
Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burns of Zhejiang Province, Hangzhou 310009, China.
World J Emerg Med. 2024;15(6):475-480. doi: 10.5847/wjem.j.1920-8642.2024.093.
Trauma-induced coagulopathy (TIC) due to serious injuries significantly leads to increased mortality and morbidity among elderly patients. However, the risk factors of TIC are not well elucidated. This study aimed to explore the risk factors of TIC in elderly patients who have major trauma.
In this retrospective study, the risk factors for TIC in elderly trauma patients at a single trauma center were investigated between January 2015 and September 2020. The demographic information including gender, age, trauma parts, injury severity, use of blood products, use of vasopressors, need of emergency surgery, duration of mechanical ventilation, length of stay in the intensive care unit (ICU) and hospital, and clinical outcomes were extracted from electric medical records. Multivariate logistic regression analysis was performed to differentiate risk factors, and the performance of the model was evaluated using receiver operating characteristics (ROC) curves.
Among the 371 elderly trauma patients, 248 (66.8%) were male, with the age of 72.5 ± 6.8 years, median injury severity score (ISS) of 24 (IQR: 17-29), and Glasgow coma score (GCS) of 14 (IQR: 7-15). Of these patients, 129 (34.8%) were diagnosed with TIC, whereas 242 (65.2%) were diagnosed with non-TIC. The severity scores such as ISS (25 [20-34] vs. 21 [16-29], <0.001) and shock index (SI), (0.90±0.66 vs. 0.58 ± 0.18, <0.001) was significantly higher in the TIC group than in the non-TIC group. Serum calcium levels (1.97±0.19 mmol/L vs. 2.15±0.16 mmol/L, <0.001), fibrinogen levels (1.7±0.8 g/L vs. 2.8±0.9 g/L, <0.001), and base excess (BE, -4.9±4.6 mmol/L vs. -1.2 ± 3.1 mmol/L, <0.001) were significantly lower in the TIC group than in the non-TIC group. Multivariate logistic regression analysis revealed that ISS>16 (: 3.404, 95%: 1.471-7.880; 0.004), SI>1 (: 5.641, 95%: 1.700-18.719; =0.005), low BE (: 0.868, 95%: 0.760-0.991; =0.037), hypocalcemia (: 0.060, 95%: 0.009-0.392; =0.003), and hypofibrinogenemia (: 0.266, 95%: 0.168-0.419; <0.001) were independent risk factors for TIC in elderly trauma patients. The AUC of the prediction model included all these risk factors was 0.887 (95%: 0.851-0.923) with a sensitivity and specificity of 83.6% and 82.6%, respectively.
Higher ISS (more than 16), higher SI (more than 1), acidosis, hypocalcemia, and hypofibrinogenemia emerged as independent risk factors for TIC in elderly trauma patients.
严重创伤所致的创伤性凝血病（TIC）显著增加老年患者的死亡率和发病率。然而，TIC的危险因素尚未完全阐明。本研究旨在探讨老年严重创伤患者发生TIC的危险因素。
在这项回顾性研究中，调查了2015年1月至2020年9月期间某单一创伤中心老年创伤患者发生TIC的危险因素。从电子病历中提取人口统计学信息，包括性别、年龄、创伤部位、损伤严重程度、血液制品使用情况、血管升压药使用情况、急诊手术需求、机械通气时间、重症监护病房（ICU）和医院住院时间以及临床结局。进行多因素逻辑回归分析以鉴别危险因素，并使用受试者工作特征（ROC）曲线评估模型性能。
371例老年创伤患者中，男性248例（66.8%），年龄72.5±6.8岁，损伤严重程度评分（ISS）中位数为24（四分位间距：17 - 29），格拉斯哥昏迷评分（GCS）为14（四分位间距：7 - 15）。这些患者中，129例（34.8%）被诊断为TIC，而242例（65.2%）被诊断为非TIC。TIC组的ISS（25[20 - 34] vs. 21[16 - 29]，<0.001）和休克指数（SI）（0.90±0.66 vs. 0.58±0.18，<0.001）等严重程度评分显著高于非TIC组。TIC组的血清钙水平（1.97±0.19 mmol/L vs. 2.15±0.16 mmol/L，<0.001）、纤维蛋白原水平（1.7±0.8 g/L vs. 2.8±0.9 g/L，<0.001）和碱剩余（BE， - 4.9±4.6 mmol/L vs. - 1.2±3.1 mmol/L，<0.001）显著低于非TIC组。多因素逻辑回归分析显示，ISS>16（比值比：3.404，95%置信区间：1.471 - 7.880；P = 0.004）、SI>1（比值比：5.641，95%置信区间：1.700 - 18.719；P = 0.005）、低BE（比值比：0.868，95%置信区间：0.760 - 0.991；P = 0.037）、低钙血症（比值比：0.060，95%置信区间：0.009 - 0.392；P = 0.003）和低纤维蛋白原血症（比值比：0.266，95%置信区间：0.168 - 0.419；P<0.001）是老年创伤患者发生TIC的独立危险因素。包含所有这些危险因素的预测模型的曲线下面积（AUC）为0.887（95%置信区间：0.851 - 0.923），敏感性和特异性分别为83.6%和82.6%。
较高的ISS（大于16）、较高的SI（大于1）、酸中毒、低钙血症和低纤维蛋白原血症是老年创伤患者发生TIC的独立危险因素。
