The Clinical Measures Of The Severe Traumatic Patients And The Analysis Of Factors Correlated To Death By Combining The PLR And MA

As one of the most common causes of death among young people,trauma also is regarded as a significant source of morbidity and mortality in all age groups.In recent years,it had been found that the process of trauma involved not only a chain reaction of coagulation,but also an important immuno-inflammatory event.When the severe trauma and hemorrhagic shock occurring,the body will release a large amount of inflammatory mediators,inducing an inflammatory response to the body or systemic inflammatory response syndrome(SIRS),resulting in excessive tissue damage or even multiple organ failure(MOF)or death.In the early stage,the predominant cause of death for acute trauma patients is uncontrollable hemorrhage and/or severe central nervous system(CNS)injury,however the leading cause of death of trauma patients in the late stage is MOF.With the extending of further study of the trauma process,especially in critically ill trauma patients,the platelet dysfunction in trauma patients has drawn a lot of attention.Not only dose platelets play a crucial role in the process of hemostasis,but also exert a non-negligible role in the process of inflammation and immunity,gaining much more important status.Platelets can be regarded as a bridge between the coagulation system and the immuno-inflammatory system.Therefore,the abnormal function of platelets may be significantly associated with the death of critically ill trauma patients.The purpose of this study was to monitor the clinical indexes of patients with severe trauma(Injury severe score,ISS score> 16 points)at admission to study the correlation with death,focusing on the investigation of the possible correlation between the combination of platelet / lymphocyte ratio(PLR)with the maximum amplitude(MA value)in thrombelastography and death.During the study,we observed the clinical data of 100 severe trauma patients admitted to our hospital from May 2015 to September 2016.According to their discharge status,all patients were divided into survival group(n = 82)and death group(n = 18).The basic clinical data,injury severe score(ISS),acute physiology and chronic health evaluation II(APACHE Ⅱ),and the blood routine,coagulation function and thromboelastometry(TEG)parameters within 1 hour after admission were recorded.All data using SPSS l7.0 statistical software for analysis.The catagorical varibles were expressed as mean ± standard deviation(?X± S)and ANOVA was used for comparison between groups.The continuous varibles were expressed as frequency and the χ2 test was used for comparison between groups.The relationship between multivariate variables was studied by Binary Logistic Backward regression analysis with 95% confidence interval,and the significance level(α)of the above tests was 0.05.The study found that: 1.the mortality rate of critically ill trauma patients was 18%.2.There was no significant difference(P>0.05)between the survival group and the death group(χ2= 1.084,0.971,2.467,P = 0.298,0.327,0.781,respectively)by the crosstab analysis of gender,age and cause of injury.3.There was significant difference(P<0.05)between the survival group and the death group by One-way ANOVA analysis(F= 27.45,37.454,7.81,13.7,13.54,4.02 respectively)of ISS score,APACHEⅡ score,LYM,D-D,FDP and Fib within 1h after admission.4.Logistic regression analysis showed that APACHEⅡ score(OR = 1.497,95% CI: 1.218-1.840,P <0.001),MA value(OR = 1.163,95% CI: 1.048-1.291,P = 0.004)(OR = 0.991,95% CI: 0.984-0.999,P = 0.018).Fib(OR = 0.971,95% CI: 0.952-0.990,P = 0.003)was positively correlated with death.5.There was a positive correlation between MA value and PLT(r = 0.508,P < 0.001)and Fib(r = 0.501,P < 0.001),which was statistically significant.In summary:1.The increase of APACHEⅡ score,MA value and the decrease of PLR,Fib within 1 hour after severe trauma patients admission can predict the poor prognosis of severe traumatic patients in the early stage.2.The application of the combination of PLR with MA value can comprehensively monitor the early coagulatory and inflammatory status of severe traumatic patients with significance to the guidance of the target therapy.