Regression Analysis Of Prognostic Factors In Patients With Acute Traumatic Coagulopathy

Objective Acute traumatic coagulopathy plays an important role in the prognosis of patients with severe trauma,and more and more attention is paid by the emergency and severe physicians.Because its pathophysiological process is complex and changeable and the development mechanisms has not been fully elucidated,the factors that affecting the prognosis has not reached a consensus.Based on the latest European Trauma Diagnostic Guidelines,this study focused on the risk factors for the prognosis of patients with acute traumatic coagulopathy by Logistic regression analysis and Cox regression analysis.Methods(1)We Collected 896 cases confirmed severe trauma patients in the First Affiliated Hospital of Zhengzhou University from February 2015 to December 2016.Finally,80 patients were brought into the study in terms of inclusion criteria.(2)Records are included in the study of gender and age of patients,injury severity score(ISS score),average temperature of 3 hours in admission,levels of lactic acid and base deficit averaged of 24 hours in admission,mean amplitude of glycemic excursions within 72 hours of admission,the transfusion of blood products,tranexamic acid and other indicators,record the time of acute coagulopathy diagnosis and coagulation function recoveried.(3)The mortality rate of acute traumatic coagulopathy as the dependent variable,with the relevant factors into the independent variables,the single factor and multivariate logistic regression analysis were performed.(4)The Cox regression analysis was operated according to the results of Logistic regression analysis.Results(1)The results of Logistic regression analysis showed that gender and age were not associated with prognosis in patients with acute traumatic coagulopathy.Injury severity score(ISS)was not statistically significant in univariate logistic regression analysis,but the result was obviously contracted in multivariate logistic regression analysis(P = 0.042 <0.05).In the univariate Logistic regression analysis,3 hours of admission average temperature(P=0.003 < 0.05),the average levels of lactic acid in admission of 24h(P=0.012 < 0.05)and base deficit level of 24 h in admission(P=0.037 < 0.05)were the prognostic factors in patients with acute traumatic coagulopathy.But the mean amplitude of glycemic excursions within 72 hours of admission,transfusion a high proportion of blood products and tranexamic acid were not statistically significant in the univariate Logistic regression analysis(P > 0.05).But in the multivariate logistic regression analysis,transfusion a high proportion of blood products(P = 0.008 <0.05)and the application of tranexamic acid(P = 0.013 <0.05)were the risk factors of prognosis,the mean amplitude of glycemic excursions was not statistically significant.(2)The results of the outcome analysis showed that,for patients with traumatic coagulopathy,the different average basal body temperature of 3 hours in admission(T?35?,33??T<35?,T<33?),the recovery time of normal curve experienced by the coagulation function,namely the outcome curve was statistically significant(Log-rank test 2? =54.376,P=0.012 < 0.05).Similarly,the mean lactic acid(Log-rank test 2? =8.141,P=0.004<0.05),base deficit level of 24 h in admission(Log-rank test 2? =14.587,P=0.001<0.05),transfusion a high proportion of blood products(Log-rank test 2? =7.006,P=0.008<0.05),the outcome curves were statistically significant.While the mean amplitude of glycemic excursions within 72 hours of admission and the application of tranexamic acid,its outcome curves were not significantly different.The results of multivariate Cox proportional hazards regression analysis showed that 3 hours of admission average temperature(RR=0.135,95%CI=0.078 to 0.233),the average levels of lactic acid in admission of 24h(RR=0.249,95% CI=0.125 to 0.498,P=0.004),base deficit level of 24 h in admission(RR=0.258,95% CI=0.126 to 0.527,P=0.010),the mean amplitude of glycemic excursions within 72 hours of admission(RR =0.392,95% CI= 0.227 to 0.677,P = 0.001),transfusion a high proportion of blood products(RR = 0.273,95% CI 0.157 to 0.475,P = 0.023),application of tranexamic acid(RR = 0.467,95% CI=0.280 to 0.779,P = 0.004),was associated with disease outcome.Conclusions(1)Gender and age are not the prognostic risk of acute traumatic coagulopathy in patients with traumatic coagulopathy prognosis assessment,and the ISS score is not of high value in the prognosis evaluation of traumatic coagulopathy.Early body temperature,acid-base balance,blood glucose fluctuation range,high proportion of blood transfusion,tranexamic acid are an independent prognostic factor in patients with acute traumatic coagulopathy.(2)To maintain admission within 3 hours the average basal body temperature greater than 35 ?,control the hospital within 72 hours of average blood glucose fluctuation less than 3.9mmol / L,correct acid-base imbalance,early high proportion of blood transfusion and application of tranexamic acid can be significantly shortened coagulation function returned to normal time,reduce the occurrence of late complications,to promote the early outcome to the benign direction of the outcome.