年龄校正rSIG指数与国际化标准比值对老年严重创伤患者预后的预测价值

Predictive value of age-adjusted rSIG index and international normalized ratio for the outcome of elderly patients with severe trauma

目的探讨年龄校正rSIG指数(rSIG/A)与国际化标准比值(INR)对老年严重创伤患者预后的预测价值。方法回顾性选取2021年1月至2023年12月丽水市人民医院急诊医学科收治的老年严重创伤患者238例为研究对象。根据预后情况分为生存组201例和死亡组37例,比较两组患者临床资料。采用ROC曲线评估rSIG/A、INR单独及两者联合预测老年严重创伤患者预后的效能。采用多因素logistic回归分析老年严重创伤患者预后的影响因素。以rSIG/A、INR最佳截断值为界分组,比较组间死亡率的差异。结果根据预后情况分为生存组201例和死亡组37例。生存组和死亡组患者INR和rSIG/A比较,差异均有统计学意义(均P<0.05)。ROC曲线分析显示rSIG/A、INR及两者联合预测老年严重创伤患者预后的AUC分别为0.826、0.732、0.846;rSIG/A、INR预测老年严重创伤患者预后的最佳截断值分别为0.26、1.20。高rSIG/A组(rSIG/A>0.26)患者死亡率低于低rSIG/A组(rSIG/A≤0.26),差异有统计学意义(P<0.05)。高INR组(INR≥1.20)患者死亡率高于低INR组(INR<1.20),差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示低rSIG/A(OR=6.689)、高INR(OR=3.205)均是影响老年严重创伤患者预后的独立危险因素(均P<0.05)。结论rSIG/A、INR对老年严重创伤患者预后有较高的预测价值,两者联合可较好地预测老年严重创伤的死亡风险。

Objective To explore the predictive value of age-adjusted reverse shock index multipliedby Glasgow Coma Scale divided by age(rSIG/A)and international normalized ratio(INR)for the outcome of elderly patients with severe trauma.Methods A retrospective selection of 238 elderly patients with severe trauma admitted to Department of Emergency Medicine in Lishui People's Hospital from January 2021 to December 2023 was conducted.According to the prognosis,201 patients were assigned to the survival group and 37 patients to the death group,and the clinical data of the two groups were compared.ROC curves were used to assess the efficacy of rSIG/A and INR alone,and the combination of both on predicting the outcome of elderly patients with severe trauma.Multivariate logistic regression was used to analyze the prognosis of elderly patients with severe trauma.Grouped by the optimal cut-off values of rSIG/A and INR,the differences in mortality between groups were compared.Results There were significant differences in INR and rSIG/A between the survival group and the death group(both P<0.05).ROC curve analysis showed that the AUCs of rSIG/A and INR alone,and the combination of both in predicting the prognosis of elderly patients with severe trauma were 0.826,0.732 and 0.846,respectively;the optimal cut-off values of rSIG/A and INR for predicting their outcome were 0.26 and 1.20,respectively.The mortality rate of patients in the high rSIG/A group(rSIG/A>0.26)was lower than that in the low rSIG/A group(rSIG/A≤0.26),and the difference was statistically significant(P<0.05).The mortality rate of patients in the high INR group(INR≥1.20)was higher than that of the low INR group(INR<1.20),and the difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that low rSIG/A(OR=6.689)and high INR(OR=3.205)were independent risk factors affecting the prognosis of elderly patients with severe trauma(both P<0.05).Conclusion rSIG/A and INR have high predictive value for the prognosis of elderly patients with severe trauma,and the combination of the two can better predict the risk of death in elderly patients with severe trauma.