Evaluation And Analysis Of Initial Ionized Calcium Combined With Trauma Scoring System In Short-term Prognosis Of ICU Trauma Patients

Objectives:1.To investigate the incidence of hypocalcemia in ICU trauma patients,and to compare the predictive efficacy of ISS,RTS,TRISS,APACHEⅡand APACHEⅣscore for 28d mortality in trauma patients.2.The risk factors of ICU trauma patients were analyzed,and the predictive value of initial i Ca²⁺combined trauma scoring system for short-term prognosis of patients was discussed,providing certain reference significance for clinical practice.Methods:Patients admitted to ICU due to trauma in our hospital from January2019 to October 2022 were selected as the study objects for retrospective analysis,and the initial i Ca²⁺,vital signs,general clinical data and laboratory test results were collected.The score of ISS,RTS,TRISS,APACHEⅡand APACHEⅣwere calculated on the day of admission.The patients were divided into survival group and deathgroup according to the 28d survival situation.The difference of basic data,biological index and various trauma scoring system between the groups were compared;The risk factors of early death in ICU trauma patients were screened out,and the value ofinitial i Ca²⁺combined trauma scoring system for short-term prognosis in ICU severe trauma patients was compared.Results:1.A total of 333 ICU trauma patients were included in this study,including 223patients with hypocalcemia and 110 patients with normal ionic calcium.The incidence of hypocalcemia was 67%.2.More men than women were found in ICU trauma patients,most of whom were aged 41 to 50,the most common injury mechanism was road traffic injury,followed by falling injury,heavy object smashing injury,fall injury and machine strangling injury.The distribution of injury locations was:limbs>chest>head and neck>abdomen>face.3.Comparison of general clinical data:There were statistically significant differences in gender,injury site（head and neck,face and chest）,emergency mechanical ventilation,use of vasoactive drugs and HR between the survival group and the death group（P<0.05）.4.Comparison of laboratory indexes:the levels of lactic acid,creatinine,urea,blood glucose and D dimer in the survival group were lower than those in the death group,while the levels of i Ca²⁺,albumin and PLT were higher,with statistical significance（P<0.05）.5.Comparison of injury scoring systems:RTS and TRISS scores in survival group were higher than those in death group,while ISS,APACHEⅡand APACHEⅣscore were lower than those in death group,and the difference was statistically significant（P<0.001）.6.With the increase of APACHEⅣscore,the predicted length of ICU stay showed an increasing trend,but was lower than the actual length of stay.7.The initial i Ca²⁺level was positively correlated with serum total calcium and albumin（r=0.518,0.500,P<0.001）,had low negative correlation with blood glucose,lactic acid,APACHEⅡand APACHEⅣscore（r=-0.363,-0.5,-0.296,-0.345,P<0.001）;8.Multivariate Logistic regression analysis showed that gender,emergency mechanical ventilation,i Ca²⁺,ISS and TRISS score were independent factors affecting early death of ICU trauma patients.（P<0.05）.ROC analysis shows that the AUC of i Ca²⁺predicting death is 0.675,which was lower than ISS（AUC=0.824,95%CI:0.745-0.903）and RTS（AUC=0.707,95%CI:0.99-0.825）,TRISS（AUC=0.813,95%CI:0.724-0.901）,APACHEⅡscore（AUC=0.787,95%CI:0.691-0.883）,APACHEⅣscore（AUC=0.778,95%CI:0.679-0.877）,but the total area under ROC curve of i Ca²⁺+ISS was 0.901（95%CI:0.849-0.953）,which was better than that of i Ca²⁺+TRISS（AUC=0.885,95%CI:0.823-0.947）.Conclusions:1.Severe trauma patients are prone to hypocalcemia in the early stage,and trauma itself is a contributing factor to hypocalcemia;2.Hypocalcemia is an independent risk factor for early death in ICU trauma patients.Initial i Ca²⁺and five trauma scores have certain predictive efficacy for prognosis,but i Ca²⁺alone has limited predictive value,and i Ca²⁺combined with ISS has better predictive value than other trauma scores.3.APACHEⅣshowed no better prediction ability than APACHEⅡ.4.The determination of i Ca²⁺on admission has certain reference significance for the preliminary assessment and diagnosis and treatment of trauma patients.