Study On The Risk Factors And Predictive Analysis Of Aldvt Following Multiple Injury Patients

PART Ⅰ PREDICTIVE VALUE OF BLOOD PLATELET/HEMOGLOBIN AND GLUCOSE OR ACUTE LOWER DEEP VEIN THROMBOSIS FOLLOWING MULTIPLE TRAUMA IN COMBINATION WITH TRAUMATIC BRAIN INJURYObjective:To explore the relationship between the acute lower deep vein thrombosis(ALDVT)and the variation of relevant laboratory indexes such as platelet count/hemoglobin(PLT/Hb),glucose(GLU)and blood coagulation parameters in patients with multiple trauma accompanied with traumatic brain injury.Methods:118 patients with multiple trauma accompanied with traumatic brain injury in trauma emergency center of Shanghai Sixth People’s Hospital from 1/2016to 12/2016 were chosen,and their clinical data were collected.The ALDVT group and the non-ALDVT group were differentiated according to the results of lower vascular ultrasound,and the incidence of ALDVT was calculated.Venous blood was collected on day 4 after trauma in all patients.Relevant parameters including PLT,Hb,GLU,Prothrombin Time(PT),International Normalized Ratio(INR),Activated Partial Thromboplastin Time(APTT),Fibrinogen(FIB),Thrombin Time(TT),Antithrombin Ⅲ(AT Ⅲ)activity,D-dimer(DD)and Fibrinogen Degradation Products(FDP)levels.we analyzed the independent risk factors of patients with multiple trauma accompanied with traumatic brain injury in the formation of ALDVT by multivariate logistic regression analysis,and the receiver operating characteristic(ROC)curves were drawn.Result:45 patients developed ALDVT of all 118 patients with multiple trauma accompanied with traumatic brain injury,accounted for 38.1%.The levels of PLT/Hb,GLU,DD and FDP in ALDVT group were higher and TT were longer than those in non-ALDVT group(all P<0.05).There were no statistical differences in PLT,PT,INR,APTT,FIB and AT Ⅲ between ALDVT group and non-ALDVT group(all P>0.05).Multivariate logistic regression analysis revealed that PLT/Hb(OR=1.699,95%CI为1.125-2.567)and GLU(OR=1.309,95%CI为1.040-1.647)were the independent risk factors influencing the formation of ALDVT in patients with multiple trauma accompanied with traumatic brain injury(both P<0.05).With the sensibility at 73%and the specificity at 70%,the cutoff value of PLT/Hb and GLU were 1.7×10~9/g and 8.3mmol/L respectively illustrated by the ROC curve.The incidence of ALDVT was 73%(86/118)when both indexes were greater than and equal to the cutoff value.Conclusion:There was a higher occurrence of ALDVT in the patients of multiple trauma accompanied with traumatic brain injury.The levels of PLT/Hb and GLU are the independent risk factors influencing the formation of ALDVT and could be predictors in diagnosis.PART Ⅱ RISK FACTORS ANALYSIS FOR ACUTE LOWER DEEP VENOUS THROMBOSIS IN MULTIPLE INJURY PATIENTSObjective:To explore the incidence and analyze the risk factors of ALDVT in multiple injury patients.Methods:175 multiple injury patients in trauma emergency center of Shanghai Sixth People‘s Hospital,from Jan.to Jun.in 2017 were chosen,and their clinical data were collected.The ALDVT group and the non-ALDVT group were differentiated according to the results of ultrasound,and the incidence of ALDVT was calculated.Univariate analysis and multivariate Logistic regression analysis were used to investigate the factors that may affect patients with ALDVT,including demographic characteristics,vital signs and hematological parameters.Result:56 patients(32%)developed ALDVT in 175 multiple injury patients.Univariate analysis showed that there were statistically significant differences in the number of multiple injury patients combined with upper limb fracture,lower limb fracture,spinal injury,pelvic fracture,chest and abdomen injury,and injury severity score(ISS)(<25 scores/≥25 scores)and glucose(<10 mmol/L/≥10 mmol/L)between two groups(all P<0.05).In the coagulation parameters,compared with the non-ALDVT group,the levels of DD and FDP in the ALDVT group were significantly elevated(both P=0.001).Multivariate Logistic regression analysis showed that the level of glucose(≥10 mmol/L)(P=0.009),ISS(≥25 scores)(P=0.024),and multiple injury with spinal injury(P=0.048)and pelvic fractures(P=0.029)were the independent risk factors of the ALDVT patients.Conclusion:There is a higher occurrence of ALDVT in multiple injury patients.The level of glucose,ISS,multiple injuries with spinal injuries and multiple injuries with pelvic fractures have important predictive significance for the diagnosis of ALDVT.