ISS与NISS LD50的获取及其在预测创伤后并发症及死亡结局中的应用

Application of LD50 of ISS and NISS to predict complications or mortality in trauma patients

目的 获取中国汉族创伤患者ISS和新ISS（NISS）的半数致死量（LD50）并探讨其对创伤后并发症及死亡结局的预测价值. 方法 对来源于中华创伤数据库收录的6 542例汉族创伤患者进行Probit回归分析,获取ISS和NISS在不同年龄段的LD50值.再利用ISS、NISS、ISSLD50ISS和NISS LD50NISS对来源于大坪医院的1 148例汉族创伤患者并发症及死亡结局进行预测.根据受试者工作特征曲线（ROC）评价预测能力.通过DeLong-DeLong非参数法比较ROC曲线下面积（AUC）评估各指标的预测价值. 结果 16 ～44岁、45～ 64岁和≥65岁三个年龄段ISSLD50值（LD50ISS）分别为55,49和33;NISS的LD50值（LD50NISS）分别为62,56和43.在预测ARDS、MODS时,ISS/LD50ISS和NISS/LD50NISS的AUC大于单独应用ISS和NISS（P＜0.05）,具有更高的预测价值.在预测脓毒症时,ISS/LD50ISS和NISS/LD50NISS与单独应用ISS和NISS具有相同的预测价值.在预测死亡时,ISS/LD50ISS和NISS/LD50NISS的AUC均＞0.9（分别为0.907和0.903）,表现出较高的预测价值. 结论 本研究提出中国汉族不同年龄段创伤患者ISS和NISS的LD50值,可作为早期预测创伤后ARDS、MODS和死亡结局的新方法.

Objective To obtain the lethal dose 50 （LD50） of injury severity score （ISS） and new injury severity score （NISS） for Chinese Han trauma patients at different ages and investigate the predictive value of the two for complications or mortality in trauma patients.Methods Data of 6,542 Chinese Han trauma patients from Chinese Trauma Databank were analyzed using Probit regression to obtain the LD50 of ISS and NISS in different age groups.ISS,NISS,ISS/LD50ISS and NISS/LD50NISS were used to predict the complications and mortality of 1,148 Chinese Han trauma patients from Daping Hospital.Receiver operating curve （ROC） analysis was performed to evaluate the predictive value.Comparison of area under the curve （AUC） was analyzed using the DeLong-DeLong non-parametric method.Results In the age groups of 16-44 years,45-64 years,and ≥65 years,LD50ISS was 55,49 and 33 respectively; LD50NISS was 62,56 and 43 respectively.To predict acute respiratory distress syndrome （ARDS） and multiple organ dysfunction syndrome （MODS）,AUC of ISS/LD50ISSor NISS/LD50NISS was greater than that of ISS or NISS （P 〈 0.05）,indicating the predictive value of ISS/LD50ISS or NISS/LD50NISS was better than that of ISS or NISS.Whereas,these scale systems provided similar predictive value for sepsis.ISS/LD50ISS and NISS/LD50NISS demonstrated good predictive value with regard to mortality （AUC of 0.907 and 0.903 respectively）.Conclusions The study works out the LD50 of ISS and NISS for Chinese Han trauma patients at different ages.ISS/LD50ISSand NISS/LD50NISS can be used as new instruments to predict ARDS,MODS and mortality in the early phase after trauma,allowing the better implementation of early intervention to improve patients＇ outcomes.