不同播散性血管内凝血评分系统预测严重创伤患者死亡率临床价值比较

Comparison of Clinical Value of Different Disseminated Intravascular Coagulation Scoring Systems in Predicting Mortality in Patients with Severe Trauma

目的探讨不同播散性血管内凝血评分(DIC)系统预测严重创伤患者死亡率临床价值。方法选择2015年1月至2018年6月在我院就诊的468例严重创伤患者进行研究,所有患者均进行日本卫生福利部评分(JMHW)、国际血栓形成和止血协会评分(ISTH)、日本急性医学协会(JAAM)、改良rJAAM(rJAAM)和韩国血栓形成和止血协会评分(KSTH)评估。观察5种DIC评分系统对28 d死亡率的预测价值。结果单因素分析显示,生存和死亡患者性别、创伤类别、受伤至救治时间、白细胞等项目相比较差异无统计学意义(P>0.05),生存和死亡率患者年龄、ISS评分、SIRS、修正创伤评分、GCS评分、体温、心率、pH值、PaCO2、碱剩余、血红蛋白、ISTH、JAAM、rJAAM、KSTH和JMHW评分均存在统计学差异(P<0.05)。以28 d死亡率为应变量,将单因素分析有意义的值引入多因素Logistic分析,结果显示,5种DIC评分中,JMHW(OR=1.412,95%CI为1.212~1.627)、KSTH(OR=1.705,95%CI为1.308~2.224)、ISTH(OR=1.375,95%CI为1.147~1.648)和rJAAM(OR=1.201,95%CI为1.082~1.427)评分与28 d死亡率显著相关(P均<0.05)。受试者工作曲线显示JMHW预测28 d死亡率的AUC高于ISTH、rJAAM、KSTH评分。结论在严重创伤患者的DIC评分中,JMHW评分对28 d死亡率具有最佳的预测价值,值得进一步研究探讨。

Objective To explore the clinical value of different disseminated intravascular coagulation(DIC)scoring systems in predicting mortality of severe trauma patients.Methods 468 patients with severe trauma treated in our hospital from January 2015 to June 2018 were selected for the study.All patients were evaluated by JMHW,ISTH,JAAM,modified rJAAM and KSTH.The predictive value of five DIC scoring systems for 28-day mortality was observed.Results The univariate analysis showed that there was no significant difference in gender,trauma type,time from injury to treatment and leukocyte count between survivors and deaths(P>0.05).There were significant differences in age,ISS score,SIRS,modified trauma score,GCS score,body temperature,heart rate,pH value,PaCO 2,alkali residue,hemoglobin,ISTH,JAAM,rJAAM,KSTH and JMHW scores between survival and mortality patients(P<0.05).The multivariate logistic analysis showed that JMHW(OR=1.412,95% CI 1.212-1.627),KSTH(OR=1.705,95% CI 1.308-2.224),ISTH(OR=1.375,95% CI 1.147-1.648)and rJAAM(OR=1.201,95% CI 1.082-1.427)were significantly correlated with 28-day mortality(P<0.05).The AUC of 28-day mortality predicted by JMHW was higher than ISTH,rJAAM and KSTH scores.Conclusion The JMHW score has the best predictive value for 28-day mortality in DIC score of patients with severe trauma,which deserves further study and discussion.