Predictive Value Of Injury Severity Score Combined With D-dimer In Mortality Of Trauma Patients

ObjectiveTo assess the severity of trauma patients and predict the prognosis of trauma patients by using the scores of injury severity score(ISS),acute physiology and chronic health evaluation(APACHE)Ⅱ,rapid emergency medicine score(REMS)and revised trauma score(RTS)and to compare the differences.To investigate the correlation between D-dimer,ISS score and mortality in trauma patients and the predictive efficacy of prognosis of trauma patients by combining D-dimer and ISS score.MethodsThe clinical data of 1592 traumatic patients admitted to our emergency room from January 1,2014 to December 31,2016 were retrospectively analyzed.Excluding standards include patients younger than 14 years old and patients with post-injury more than 24 hours,clinically death at admission,automatic discharge or patients without complete data;patients with previous coagulopathy,primary liver function failure,anticoagulants used within 6 months prior to injury;patients with less than 2 sites of injury.finally a total of 1167 patients were enrolled in this study.The ISS score,APACHE Ⅱ score,RTS score and REMS score were calculated and divided into different injury severity grades according to the scoring results.Patients were divided into survival group and death group with 28-day outcome as the end point.Differences between the four scores in the death group and the survival group were compared,and the differences and trends in the mortality among the different grades were compared.The receiver operating characteristic(ROC)curve of four kinds of scores was generated for predicting the patient mortality.The area under the ROC curve was compared to evaluate the predictive efficacy of the four kinds of scores.Through the multi-factor logistics analysis,screening hematological indicators as risk factors which predict the mortality.D-dimer of venous blood was selected to compare the difference and its relationship with mortality between death group,survival group as well as subgroups divided by ISS score grades.Meanwhile,the area under the ROC curve was used to compare the accuracy of D-dimer,ISS score and the combination of the two in predicting the prognosis of patients.Results.The scores of ISS,APACHE Ⅱ and REMS in death group were higher than those in survival group(t = 6.187,15.04 and 11.411,respectively,P<0.05),but the RTS score was lower than that in survival group(t =-9.25,P<0.05).Mortality is showed as increasing trend along with the increasing of ISS score,REMS score,APACHE Ⅱscore and the decreasing of RTS score(χ2 values were 70.85,109.71,351.59,190.04,P<0.05 respectively).The area under the ROC curve of APACHE Ⅱ score was the largest(0.918 ± 0.0176),besides,the REMS score was similar to RTS score(0.857 ±0.0231 and 0.858 ± 0.0253,respectively).The area under the ISS score curve was the smallest(0.728 ± 0.0296).WBC,TT,APTT,D-dimer,Tbil,Dbil,Creatine CK-MB,LDH,C-reactive protein(CRP)are the hematological indicators that have a significant effect on the death of trauma patient.The D-dimer level in survival group was significantly lower than that in the death group(t = 7.882,P<0.01).The area under the ROC curve of ISS score,D-dimer and their combination were 0.728,0.765 and 0.800,The area under the ROC curve of D-dimer for predicting patients’ prognosis was larger than that of ISS,but the difference was not statistically significant(Z = 1.051,P = 0.293).The area under the ROC curve of combination of the two is larger than that of ISS score or D-dimer alone(Z values were 3.028,2.272,P<0.05 respectively).ConclusionThe four kinds of scores showed certain predictive ability in patients’ prognosis.APACHE II score system has the best predictive value for patient mortality,REMS score and RTS score are inferior to APACHE Ⅱ score,and ISS score is the worst.The level of D-dimer was correlated with the severity and mortality of trauma patients.The combination of ISS score and D-dimer appeared with better predictive efficacy in predicting the mortality and better performance than D-dimer or the ISS score alone in predicting the prognosis of death of traumatic patients.