成年急性创伤性休克患者预后预测因素分析

Predictors for prognosis of adult patients with acute traumatic shock

目的探讨影响成年急性创伤性休克患者的预后因素。方法采用回顾性队列研究分析2013年7月至2021年9月聊城市第二人民医院收住ICU的122例成年急性创伤性休克患者的临床资料, 其中男90例, 女32例;年龄18~83岁[(49.8±16.9)岁]。损伤严重度评分(ISS)为14~50分[(28.6±6.3)分]。根据患者预后情况分为预后良好组(48例)和预后不良组(74例)。比较两组性别、年龄及急诊入院时的白细胞计数、中性粒细胞计数、淋巴细胞计数、血小板计数、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、D-二聚体、乳酸、ISS和休克指数(SI)。采用单因素逐步回归分析及多因素Logistic回归分析确定影响预后的因素。采用受试者工作特征(ROC)曲线分析对影响预后的因素进行预测价值的评价, 计算曲线下面积(AUC)、灵敏度、特异度和最佳预测临界值, 并对预后有影响的因素进行分层分析。结果两组性别、血小板计数、D-二聚体、ISS和SI差异无统计学意义(P均>0.05);预后不良组年龄、淋巴细胞计数和乳酸水平高于预后良好组, 而白细胞计数、中性粒细胞计数、NLR和PLR低于预后良好组(P均<0.01)。单因素逐步回归分析结果显示, 年龄和NLR与急性创伤性休克患者预后有一定相关性(P均<0.01), 而性别、白细胞计数、中性粒细胞计数、血小板计数、PLR、D-二聚体、乳酸、ISS和SI与患者预后无明显相关性(P均>0.05)。多因素Logistic回归分析结果表明, 年龄(OR=0.96, 95%CI 0.93~0.98)和NLR(OR=1.19, 95%CI 1.10~1.29)是急性创伤性休克患者预后的影响因素。ROC曲线分析结果显示, 年龄的AUC为0.32(95%CI 0.22~0.41, P<0.01), 最佳预测临界值为48.5岁(敏感度68.9%, 特异度64.6%);NLR的AUC为0.79(95%CI 0.71~0.90, P<0.01), 最佳预测临界值为6.51(敏感度77.1%, 特异度71.6%)。分层分析结果显示, 随着年龄的增长, 预后不良组所占比例逐渐升高(P<0.01);随着NLR水平的升高, 预后不良组所占比例明显下降(P<0.01)。结论年龄和急诊入院时NLR水平可以预测成年急性创伤性休克患者的预后, 且最佳预测临界值分别为48.5岁、0.79。另外, 高龄和较低水平NLR的急性创伤性休克患者预后较差。

Objective To analyze the predictive factors for prognosis of adult patients with acute traumatic shock.Methods A retrospective cohort study was used to analyze the clinical data of 122 adult patients with acute traumatic shock treated in ICU of Second People′s Hospital of Liaocheng from July 2013 to September 2021.There were 90 males and 32 females with the age range of 18-83 years[(49.8±16.9)years].Injury severity score(ISS)was 14-50 points[(28.6±6.3)points].According to the prognosis,the patients were divided into good prognosis group(n=48)and poor prognosis group(n=74).The gender,age,and leukocyte count,neutrophil count,lymphocyte count,platelet count,neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),D-dimer,lactic acid,ISS and shock index(SI)on emergency admission were compared between the two groups.Univariate stepwise regression analysis and multivariate Logistic regression analysis were used to screen the indicators affecting the prognosis of patients with acute traumatic shock.Predictive value of the indicators affecting patients′prognosis were analyzed by receiver operating characteristic(ROC)curve,and the area under the curve(AUC),sensitivity,specificity and optimal cut-off value were calculated.The indicators affecting the prognosis were analyzed by stratification analysis.Results There was no significant difference between the two groups in gender,platelet count,D-dimer,ISS and SI(all P>0.05).The age,lymphocyte count and lactate level in poor prognosis group were higher than those in good prognosis group,while the leukocyte count,neutrophil count,NLR and PLR in poor prognosis group were lower than those in good prognosis group(all P<0.01).Univariate stepwise regression analysis showed that age and NLR were related to the prognosis of patients with acute traumatic shock(all P<0.01).While the gender,leukocyte count,neutrophil count,platelet count,PLR,D-dimer,lactic acid,ISS and SI had no correlation with the prognosis(all P>0.05).Multivariate Logistic regression analysis showed that age(OR=0.96,95%CI 0.93-0.98)and NLR(OR=1.19,95%CI 1.10-1.29)were the affecting factors for prognosis of patients with acute traumatic shock.ROC analysis showed the AUC of age for 0.32(95%CI 0.22-0.41)together with the optimal cut-off value predicting prognosis for 48.5 years(sensitivity 68.9%,specificity 64.6%),the AUC of NLR for 0.79(95%CI 0.71-0.90)together with the optimal cut-off value predicting prognosis for 6.51(sensitivity 77.1%,specificity 71.6%).Stratified analysis showed that the proportion of patients in poor prognosis group was increased gradually with the increase of age(P<0.01),while that was decreased significantly with the increase of NLR level(P<0.01).Conclusions Age and level of NLR on emergency admission can predict the prognosis of adult patients with acute traumatic shock,with the best cut-off value of 48.5 years and 0.79.Moreover,advanced age and lower level of NLR indicate much poorer prognosis.