| ObjectiveThrough cross-sectional case-control study of clinical data from transfused trauma patients,and to explore the related factors of clinical prognosis of transfused trauma patients.Through the analysis of influencing factors of massive transfusion in transfused trauma patients,to establish a massive transfusion prediction scoring program and validate the clinical application performance.MethodCollected all the trauma patients’ clinical data in the first affiliated hospital of Nanchang university from January 1,2013 to December 31,2016,a total of 265 cases which were over 18 years old and had red blood cells(RBC)transfusion within 24 hours after admission were included.According to the units of RBC transfusion within 24 hours after admission,the patients was divided into massive transfusion group(the units of RBC transfusion in 24 h ≥ 18u)and non-massive transfusion group(the units of RBC transfusion in 24 h < 18u),and including 36 cases of massive transfusion patients,229 cases of non-massive transfusion group.(1)Analyzed and compared two groups’ patients with clinical data and clinical prognosis indicators,and used Logistic regression analysis to analyze the influence factors related to in-hospital mortality,to explore the factors of clinical prognostic of transfused trauma patients.(2)Used linear regression to analysis the related factors of volume of RBC transfusion,screened out the independent predictors of transfused trauma patients with massive transfusion.(3)Used independent factors as predictors of massive transfusion,the independent predictors were assigned to build massive transfusion predictive score program,and used the receiver operating characteristic curve(ROC curve)to validate clinical application performance.Result(1)There was no significant difference in sex,age and cause of injury between the patients with massive transfusion and non-massive transfusion(P > 0.05).The difference between two groups with injury severity score(ISS),Glasgow Coma Scale(GCS),heart rate(HR),systolic blood pressure(SBP),hemoglobin(Hb)and blood coagulation indexes were statistically significant(P < 0.05).(2)The 60 days mortality rate and total mortality rate in patients with massive transfusion group was significantly higher than that of non-massive transfusion group(P < 0.05),the rate of nosocomial infection,time of mechanical ventilation,ICU stay and total length of stay were also higher than those in non-massive transfusion group(P<0.05),two groups of patients had no adverse reactions of blood transfusion.(3)Analysis of influential factors of clinical prognosis in transfused trauma patients:(1)Logistic univariate regression analysis showed that ISS,GCS,RBC and fresh frozen plasma transfusion volume,nosocomial infection,time of mechanical ventilation,ICU stay and total length of stay were risk factors for in-hospital death in transfused trauma patients(P<0.05).(2)Logistic multivariate regression analysis showed that ISS,RBC transfusion and nosocomial infection were independent risk factors of in-hospital death in transfused trauma patients(P<0.05).(3)The area under ROC curve(AUC)of regression model was 0.80,which shows regression model has high diagnostic performance.(4)Analysis of the impact factors of transfused trauma patients with massive transfusion and prediction:(1)Univariate linear regression analysis showed that the type of trauma,ISS,HR,SBP,Hb,prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fbg),international normalized ratio(INR),base excess(BE)were the influential factors of massive transfusion in transfused trauma patients(P<0.05).(2)Multivariate logistic regression analysis showed that the type of trauma,ISS,HR,Hb,PT,Fbg and BE were independent predictors of massive transfusion in transfused trauma patients(P<0.05).(3)Through layered assign the independent predictors of massive transfusion in transfused trauma patients,established a prediction scoring program of massive transfusion,the total score of massive transfusion predictive program was 0-8.ROC curve analysis showed that the AUC=0.91,the sensitivity and specificity were 88.9% and 79.9%,when the score is more than 4 points,that requires massive blood transfusion.ConclusionThe incidence of complications and mortality rate were significantly higher in transfused trauma patients with massive transfusion,and ISS,RBC transfusion and nosocomial infection were independent risk factors for in-hospital mortality.The type of trauma,ISS,HR,Hb,PT,Fbg and BE were independent predictors of massive transfusion in transfused trauma patients,the massive transfusion predictive scoring program was established and has high clinical application performance,when the score is greater than 4 points,that requires massive blood transfusion.. |
