RTS评分联合BAR预测急诊创伤绿色通道患者预后的回顾性研究  

A retrospective study of the RTS combined with BAR to predict prognosis of patients in emergency trauma green channel

作　　者：方熙 刘丹 李华[1] 李琳[1] 康健[1] 周浩[1,2] FANG Xi;LIU Dan;LI Hua;LI Lin;KANG Jian;ZHOU Hao(Emergency Department,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029;Key Laboratory of Aid and Trauma Research of the Education Ministry,College of Emergency and Trauma,Hainan Medical University,Haikou 571199,China)

机构地区：[1]南京医科大学第一附属医院急诊科,江苏南京210029 [2]海南医学院急诊创伤学院急救与创伤研究教育部重点实验室,海南海口571199

出　　处：《南京医科大学学报（自然科学版）》2023年第11期1562-1567,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省高校自然科学研究项目(16KJB320003);急救与创伤研究教育部重点实验室(海南医学院)开放课题基金(KLET-202120)。

摘　　要：目的:对比血浆白蛋白(albumin,ALB)、血尿素氮(blood urea nitrogen,BUN)与血尿素氮/白蛋白比值(blood urea ni-trogen/albumin ratio,BAR)对创伤绿色通道患者28 d死亡的预测价值,并联合修正创伤评分(revised trauma score,RTS)构建预测患者28 d死亡的模型。方法:回顾性分析2020年1—12月南京医科大学第一附属医院创伤绿色通道患者的临床资料,比较28 d生存组与死亡组年龄、性别、既往史、RTS评分、创伤严重程度评分、实验室检查结果,并用受试者工作特征(the receiver operating characteristic,ROC)曲线确定ALB、BUN和BAR的临界值,通过DeLong非参数方法对比ALB、BUN与BAR预测28 d死亡的ROC曲线下面积(the area under the ROC curve,AUROC)。将RTS评分分别联合上述3个指标构建预测模型,Hosmer-Leme-show检验评价模型效果,并对比模型的预测效果。结果:最终纳入419例患者,年龄(54.3±16.4)岁,男309例(73.7%),入院前时间4.0(2.0,6.0)h,28 d死亡率7.6%(32/419)。ROC曲线示ALB≤29.5 g/L、BUN>6.97 mmol/L、BAR>7.39 mg/g分别是预测急诊创伤绿色通道患者28 d死亡的临界值,且BAR的预测效果优于ALB与BUN。RTS评分分别联合ALB、BUN与BAR构建预测模型RTS-ALB、RTS-BUN与RTS-BAR,预测效果均优于RTS评分,其中RTS-BAR的AUROC最大,但RTS-BAR与RTS-ALB、RTS-ALB与RTS-BUN的AUROC差异无统计学意义。结论:BAR预测创伤绿色通道患者28 d死亡的能力优于ALB与BUN,BAR>7.39 mg/g提示预后不佳。RTS评分联合BAR能预测创伤绿色通道患者的预后。Objective:To compare the predictive value of serum albumin(ALB),blood urea nitrogen(BUN)and blood urea nitrogen/albumin ratio(BAR)for 28-day mortality of patients in trauma green channel,and to construct a model for predicting 28-day mortality by combining the revised trauma score(RTS).Methods:The clinical data of patients in trauma green channel between January 2020 and December 2020 in the First Affiliated Hospital of Nangjing Medical University were retrospectively analyzed to compare the demographic differences,past history,RTS,injury severity score,and laboratory results between 28-day survival group and death group.The cut-off values of ALB,BUN and BAR were determined by receiver operating characteristic(ROC)curve,and the area under the ROC curve(AUROC)of ALB,BUN and BAR in predicting 28-day mortality was compared by DeLong non-parametric method.The RTS was combined with each of the above three indicators to construct a prediction model respectively,and the Hosmer-Lemeshow test was used to evaluate the model effect and compare the prediction effect of the models.Results:Finally,419 patients were included with 309 men(73.7%),aged(54.3±16.4)years,prehospital time of 4.0(2.0,6.0)h,and 28-day mortality of 7.6%(32/419).The ROC curve showed that ALB≤29.5 g/L,BUN>6.97 mmol/L and BAR>7.39 mg/g were the cut-off values to predict the 28-day mortality of patients in trauma green channel,and the predictive effect of BAR was better than that of ALB and BUN.RTS-ALB,RTS-BUN and RTS-BAR were used to construct the predictive models of the RTS combined with ALB,BUN and BAR,respectively.The predictive effect of these three models was better than that of the RTS,and AUROC of RTS-BAR was the largest,but there was no statistical difference between the AUROC of RTS-BAR and RTS-ALB,and between the AUROC of RTS-ALB and RTS-BUN.Conclusion:BAR is superior to ALB and BUN in predicting 28-day mortality of patients in trauma green channel,and patients with BAR>7.39 mg/g are indicated poor prognosis.The RTS combined with BAR also has

关 键 词：血尿素氮/白蛋白 修正创伤评分 创伤绿色通道 预后 

分 类 号：R605.97[医药卫生—急诊医学]