The Value Of Noninvasive Hemodynamic Monitoring Combined With Lactic Acid In Prognosis Evaluation Of Patients With Traumatic Hemorrhagic Shock

Objective:To evaluate the prognostic value of early hemodynamic indexes,lactic acid,and its combined indexes in patients with traumatic hemorrhagic shock.Methods:This is a prospective observational study.A total of 73 patients with traumatic hemorrhagic shock admitted to the emergency room and intensive care unit of Changshu Hospital,Affiliated with Soochow University,from October 2020 to January 2023,were selected.General data,Lac and non-invasive hemodynamic indexes of patients were collected and divided into survival group and death group according to 28-day survival,and the differences in data between the two groups were compared.Multivariate Logistic regression was used to analyze the independent risk factors of 28-day death,the 28-day death prediction model was established,and the ROC curve was drawn to evaluate the prognostic value of each indicator.The optimal cutoff values of Lac and hemodynamic indexes were used for grouping analysis.Results:1.Among the 73 patients with traumatic hemorrhagic shock,38 cases(52.1%)were ≥60 years old,42 cases(57.5%)were male,and 29 cases(39.7%)had a history of basic hypertension.Lac,CI,SV and SVI at 24 hours were lower than those at 0 hours(all P<0.05),the TFC at 24h was higher than that at 0h(P<0.05),there was no significant difference in CO,HR,MAP,TPR and TPRI between 0h and 24h(all P>0.05).2.By comparing the clinical data of the survival group and the death group,we found that there were no significant differences in age,sex ratio,underlying diseases and causes of injury between the two groups(all P>0.05).The ISS of the survival group was lower than that of the death group(P<0.05),and the GCS of the survival group was higher than that of the death group(P<0.05).Lac levels at 0h and 24h in the death group were higher than those in the survival group(P<0.05),24hLac in the survival group was significantly lower than 0hLac(P<0.05),there was no statistical significance in 24hLac compared with 0hLac in death group(P>0.05).There were no significant differences in HR,MAP.TPR and TPRI at 0h and 24h between the two groups(all P>0.05).The CO.CI.SV and SVI at 0h and 24h in the survival group were higher than those in the death group(all P<0.05).0hTFC and 24hTFC in the death group were higher than those in the survival group(P<0.05).The comparison between 24hTFC and 0hTFC in the death group showed that 24hTFC was significantly higher than 0hTFC(P<0.05).3.Univariate and multicollinearity analyses suggested that prognostic indicators included GCS.ISS,0hLac,0hCO,0hSV,0hTFC,24hLac,24hCO,24hSV,24hTFC(all P<0.05).which were included in multivariate Logistic regression analysis.The results showed that ISS,0hCO,and 24hLac were independent risk factors for death at 28-day(P<0.05).4.ISS,0hCO combined with 24hLac established a 28-day death prediction model for patients with traumatic hemorrhagic shock:logit(P)=0.087+0.179 X(ISS,points)-1.702×(0hCO,L/min)+0.419 X(24hLac,mmol/L).ROC curve analysis results showed that The area under ROC curve(95%CI)of ISS,0hCO,24hLac and their combined prediction models for 28-day death were respectively 0.736(0.612～0.860),0.796(0.683～0.909),0.820(0.696～0.944)and 0.938(0.859～1.000),the area under ROC curve of the combined prediction model was more significant than ISS,0hCO and 24hLac(all P<0.05).The truncation values,sensitivity and specificity of ISS,0hCO,24hLac and joint prediction models were 23.50(86%,55%),4.56(86%,63%),4.24(77%,88%)and 0.27(96%.92%),respectively.5.All patients were divided into two groups according to the cutoff value of 24hLac.The 0hCO of the 24hLac≤4.24 mmol/L group was significantly higher than that of the 24hLac>4.24mmol/L group(P<0.05),and the 28-day mortality was significantly lower than that of 24hLac>4.24mmol/L group(P<0.05).Patients were divided into two groups according to the truncation value of 0hCO.The 28-day mortality rate of patients in the 0hCO≤4.56 L/min group was significantly higher than that in the 0hCO>4.56L/min group(P<0.05).Conclusions:1.Timely and accurate monitoring of hemodynamics and Lac is valuable for the prognosis of patients with traumatic hemorrhagic shock.2.The combined prediction model established by Nicom-monitored 0hCO,ISS and 24hLac showed high predictive efficacy for 28-day death in patients with traumatic hemorrhagic shock.