多发伤患者院内死亡独立危险因素分析及预测模型的构建与验证  

Analysis of independent risk factors and establishment and validation of a prediction model for in‑hospital mortality of multiple trauma patients

作　　者：苗振军[1] 张登奎 梁亚鹏[1] 周峰[1] 刘志祯[1] 蔡华忠[1] Miao Zhenjun;Zhang Dengkui;Liang Yapeng;Zhou Feng;Liu Zhizhen;Cai Huazhong(Department of Emergency,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,China)

机构地区：[1]江苏大学附属医院急诊中心,镇江212001

出　　处：《中华创伤杂志》2023年第7期643-651,共9页Chinese Journal of Trauma

摘　　要：目的探讨多发伤患者院内死亡的独立危险因素,构建死亡风险预测模型并验证其效能。方法采用回顾性队列研究分析2011年1月至2021年12月江苏大学附属医院收治的1028例多发伤患者临床资料,其中男765例,女263例;年龄18~91岁[(53.8±12.4)岁]。损伤严重度评分(ISS)16~57分[(26.3±7.6)分]。死亡153例,生存875例。将2011年1月至2018年12月收治的777例作为构建模型的训练集,而将2019年1月至2021年12月收治的251例作为模型的验证集。根据患者的预后结局,将训练集分为死亡组(115例)和生存组(662例)。比较两组性别、年龄、基础疾病、致伤机制、头颈部损伤、颌面部损伤、胸部损伤、腹部损伤、四肢骨盆损伤、体表损伤、损害控制手术、就诊时间、损伤部位数、格拉斯哥昏迷评分(GCS)、ISS、休克指数,以及入院6 h内的实验室检查结果包括血乳酸、白细胞计数、中性粒细胞/淋巴细胞比率(NLR)、血小板计数、血红蛋白、活化部分凝血活酶时间(APTT)、纤维蛋白原、D-二聚体及血糖。采用单因素分析和多因素Logistic回归分析确定多发伤患者院内死亡的独立危险因素,基于上述独立危险因素采用R软件构建列线图预测模型,在训练集和验证集中分别绘制受试者工作特征(ROC)曲线下面积(AUC)、校正曲线和临床决策曲线分析(DCA),并进行Hosmer-Lemeshow拟合优度检验。结果单因素分析结果显示,腹部损伤、四肢骨盆损伤、损害控制手术、GCS、ISS、休克指数、血乳酸、白细胞计数、NLR、血小板计数、血红蛋白、APTT、纤维蛋白原、D-二聚体及血糖与多发伤患者院内死亡有一定的相关性(P<0.05或0.01)。多因素Logistic回归分析结果表明,GCS≤8分(OR=1.99,95%CI 1.12,3.53)、ISS>25分(OR=7.39,95%CI 3.50,15.61)、休克指数>1.0(OR=3.43,95%CI 1.94,6.08)、血乳酸>2 mmol/L(OR=9.84,95%CI 4.97,19.51)、纤维蛋白原≤1.5 g/L(OR=2.57,95%CI 1.39,4.74)及血糖>Objective To explore the independent risk factor for in-hospital mortality of patients with multiple trauma,and to construct a prediction model of risk of death and validate its efficacy.Methods A retrospective cohort study was performed to analyze the clinical data of 1028 patients with multiple trauma admitted to Affiliated Hospital of Jiangsu University from January 2011 to December 2021.There were 765 males and 263 females,aged 18-91 years[(53.8±12.4)years].The injury severity score(ISS)was 16-57 points[(26.3±7.6)points].There were 153 deaths and 875 survivals.A total of 777 patients were enrolled as the training set from January 2011 to December 2018 for building the prediction model,while another 251 patients were enrolled as validation set from January 2019 to December 2021.According to the outcomes,the training set was divided into the non-survival group(115 patients)and survival group(662 patients).The two groups were compared in terms of the gender,age,underlying disease,injury mechanism,head and neck injury,maxillofacial injury,chest injury,abdominal injury,extremity and pelvis injury,body surface injury,damage control surgery,pre-hospital time,number of injury sites,Glasgow coma score(GCS),ISS,shock index,and laboratory test results within 6 hours on admission,including blood lactate acid,white blood cell counts,neutrophil to lymphocyte ratio(NLR),platelet counts,hemoglobin,activated partial thromboplastin time(APTT),fibrinogen,D-dimer and blood glucose.Univariate analysis and multivariate Logistic regression analysis were performed to determine the independent risk factors for in-hospital mortality in patients with multiple trauma.The R software was used to establish a nomogram prediction model based on the above risk factors.Area under the receiver operating characteristic(ROC)curve(AUC),calibration curve and clinical decision curve analysis(DCA)were plotted in the training set and the validation set,and Hosmer-Lemeshow goodness-of-fit test was performed.Results Univariate analysis showed that abd

关 键 词：多处创伤 死亡 乳酸 危险因素 列线图 

分 类 号：R459.7[医药卫生—急诊医学]