| Objective:To explore the risk factors of multiple organ dysfunction syndrome in severe trauma patients,and put forward a new warning scoring system of multiple organ dysfunction syndrome.It can provide a more accurate scoring method for doctors to judge the clinical condition and prognosis of patients.Methods: The clinical data of patients with severe trauma,who were treated at ICU in Daping Hospital of the Third Military Medical University and the Affiliated Hospital of Zunyi Medical College in 2015.1-2016.12 years,were retrospectively analyzed.The clinical outcomes were divided into groups MODS(251 cases)and non-MODS group(91 cases)according to the patient's hospitalization.Records of two groups of patients with gender and age;respiratory rate,heart rate,systolic blood pressure after admission to the hospital within 24 h;serum creatinine(SCr),Indicators of blood routine and blood biochemistry of the difference;sequential organ failure assessment(SOFA),new injury severity score(ISS)and so on;whether the emergency intubation or surgery within 24 h;whether they developed sepsis and the clinical outcomes.Single factor analysis of the two groups were observed,the regression analysis on the related factors leading to MODS for further logistic,the selected risk factors influence the occurrence of MODS in trauma patients,and to assign the significant index score for MODS warning;draw the receiver operating characteristic curve(ROC),evaluation MODS early warning score for predicting the occurrence of MODS in patients with severe trauma.(The observed indicators of the two groups were analysed using one-way ANOVA,and the related factors leading to MODS were further analysed by regression analysis.Then the risk factors influence the occurrence of MODS in trauma patients were selected.We assigned the significant index score for MODS warning,draw the receiver operating characteristic curve(ROC),as well as evaluated MODS early warning score for predicting the occurrence of MODS in patients with severe trauma.)Results: Compared with non MODS group,MODS group P(pulse / min: 98.30±24.48 to 87.99 ±19.19,t=-3.63,p=0.0004,Na+(mmol/L:139.10±4.56 to 137.50 ±4.07,t =-2.93,p= 0.0037),SCr(umol/L:87.65±71.85 to 69.09 ±21.68,t=-2.42,p=0.0159,APTT(S:41.13±27.04 to 31.90±9.84,t=-3.14,p=0.0018)were significantly increased;ISS score(score:25.77±13.49 to 18.46±10.34,t=-4.05,p < 0.0001),NISS score(score: 29.96±15.16 to 22.49±13.30,t=-4.15,p<0.0001),APACHE ? score(score:15.43±5.56 to 11.68±5.14,t=-5.62,p<0.0001)and SOFA(score: 6.82±2.98 to 4.03±2.24,t=-8.11,p<0.0001)increased;causes of injury [43.43% traffic trauma(109/251),falling injury in 39.04%(98/251),and 17.53% other injuries(44/251)to 23.08%(21/91),52.75%(48/91),24.18%(22/91),?2=11.742,p=0.0028] multiple trauma [70.52%(177/251)to 51.65%(47/91),?2=10.523,p=0.0012] the number of injured parts [1 27.49%(69/251),2 22.71%(57/251),?3 49.80%(125/251)to 51.65%(47/91),20.88%(19/91),27.47%(25/91),?2=19.184,p < 0.0001],shock at admission [46.61%(117/251)/13.19%(12/91),?2=31.766,p<0.0001],blood transfusion [81.27%(204/251)to 70.33%(64/91),?2=4.719,p=0.0298],central venous catheter [82.07%(206/251)to 51.65%(47/91),?2=11.374,p=0.0007],emergency intubation [87.65%(220/251)to 76.92%(70/91),?2= 5.960,p=0.0146] and the infection ratio [75.30%(189/251)to 51.65%(47/91),?2=17.466,p<0.0001] also significantly elevated;blood p H(7.40±0.09 to 7.42±0.07,t=2.05,p=0.0414),RBC(×109/L:3.29 ±0.90 to 3.75±0.75,t=4.40,p<0.0001),PLT(×109/L:124.50±81.82 162.50±71.57,t = 3.92,p = 0.0001),albumin(g/L:28.09±8.49 to 32.21±8.46,t=3.96,p< 0.0001)and GCS(score: 10.29±4.17 to 13.29±2.95,t= 6.29,p< 0.0001)remarkably decreased;and the differences between two groups in gender,age,blood pressure,heart rate,WBC,PCT,the occurrence of ARDS,and the proportion of emergency operation were no statistical significance.(There were no significant differences in gender,age,blood pressure,heart rate,WBC,PCT,the occurrence of ARDS,and the proportion of emergency operation between the two groups.The indicators,statistically significant using the singlue factor analysis,were further assessed by logistic multivariate regression analysis)The single factor analysis of the indicators were statistically significant for logistic multivariate regression analysis,regression model into the indicators were the number of injured parts of more than 3(95%CI=1.424 ~ 5.390,p=0.0027),shock at admission(95%CI=1.398 ~ 5.863,p=0.0040),15 ?APACHE II score? 20 points(95%CI = 1.366 ~5.319,p=0.0040),APACHE II score? 21 points(95%CI=1.166~8.661,p=0.0238);4?SOFA? 6 score(95%CI=1.215~4.538,p=0.0111),SOFA?7 score(95%CI=2.034~10.396,p=0.0002);APTT>40 seconds(95%CI = 1.593 ~9.263,p= 0.0027),which were assigned to1.0,1.0,1.0,1.0,1.0,1.5,1.5,The total score of the 7 indicators was used as the MODS warning score.ROC curve analysis showed that MODS score in the pr ediction of early warning ROC curve of trauma patients MODS area(AUC)was 0.822,significantly higher than that of APACHE? score(AUC = 0.698,p = 0.0001),APTT(AUC = 0.693,p < 0.0001)and SOFA score(AUC = 0.77,p= 0.0249).When the MODS diagnostic threshold warning score was 2.5 points,the sensitivity was 61.35%,specificity was 90.11%,the positive predictive value was 94.5%,the negative predictive value was 45.8%,the positive likelihood ratio was 6.2,the negative likelihood ratio was 0.43,and Youden index was 0.5146.Conclusion: The number of injured parts more than 3,shock at admission,APACHE ? score more than 15 points,SOFA score more than 4 points,APTT more than 40 seconds are risk factors in critically trauma patients with MODS.In this study,the beta value of the above five indicators is assigned,which constitutes a new MODS warning score,and the predictive value is better than APACHE II,SOFA,GCS,showing a good early warning effect,suggesting that it can be used as a scoring system to predict the occurrence of MODS in severe trauma patients and help medical workers to evaluate the incidence and prognosis of MODS more quickly and accurately. |
PDF Full Text Request