Analysis Of Clinical Features And Early Risk Factors Of Multiple Trauma Complicated With PICS

Objective:1.To summarize the clinical features and further clarify the clinical significance of persistent inflammation,immunosuppression,and catabolism syndrome(PICS)by analyzing the clinical data of multiple trauma complicated with PICS.2.To explore the early risk factors and predictive value of multiple trauma complicated with PICS,also to provide reference for early identification of patients with PICS high-risk.Methods:163 patients with multiple trauma admitted to intensive care unit from January 2017 to December 2020 in trauma center of a third Class A Hospital were observed retrospectively.According to the diagnostic criteria of PICS,the patients were divided into PICS group and non-PICS group.To compare and analyze the difference of clinical data,such as general clinical data,admission laboratory test index,hospital complications and prognosis between the two groups,to summarize the clinical characteristics and further clarify the clinical significance of the PICS.A multi-factor Logistic regression analysis was carried out on the index with statistical difference on admission day to explore the early independent influencing factors of multiple trauma complicated with PICS and a ROC curve was performed to evaluate its prediction efficiency.Results:1.This study includes 163 patients with multiple trauma,including 44 in PICS group(27%)and 119 in non-PICS group(73%).2.General comparison:PICS group has higher age,APACHEII score and SOFA score than non-PICS group(P<0.05),significant differences in age and APACHEII score(P<0.01),but there are no statistical difference in gender ratio,BMI,ISS score,hemorrhagic shock ratio,injury mechanism and injury site between the two groups(P>0.05).There are more male patients than female in both groups,the most common injuries are caused by accidents and high falls.The order of vulnerable sites from high to low is limbs,chest,abdomen,head,neck.3.Comparison of test indicators:PICS group has lower albumin,lymphocyte count,CD4+%and CD4+/CD8+ratio than non-PICS group(P<0.05),whereas glucose,procalcitonin and C reactive proteins are higher than those in non-PICS group(P<0.05),there is no significant difference in other indicators between the two groups(P>0.05).4.Comparison of complications:①Complications of infection:The incidence of nosocomial infection is high in both groups.The incidence of nosocomial infection and sepsis in PICS group is significantly higher than that in non-PICS group(P<0.01),there is no statistical difference in common infection(P>0.05).The incidence of pulmonary and injury site infection in PICS group is significantly higher than that in non-PICS group(P<0.01),there is no statistical difference in urinary tract and blood infection(P>0.05).The order of infection sites in the PIGS group from high to low is lung,injury site,urinary,blood and in the non-PICS group from high to low is lung,urinary,injury,blood.②Organ dysfunction:The incidence of lung,liver,cardiovascular,kidney,coagulation and central nervous system dysfunction in PICS group is higher than that in non-PICS group(P<0.05).The order of vulnerable organs in PICS group from high to low is lung,liver,kidney,circulatory system,coagulation,central nervous system and the order of vulnerable organs in the non-PICS group from high to low is lung,liver,circulatory system,coagulation,kidney and central nervous system.Moreover,the incidence of multiple organ dysfunction and multiple organ failure in PICS group is significantly higher than that in non-PICS group(P<0.01).5.Comparison of clinical outcome:The proportion of mechanical ventilation,ventilation time,ICU retention time,hospitalization cost and hospital mortality in PICS group are significantly higher than those in non-PICS group(P<0.01).6.Multiple factors Logistic regression analysis:Age is an independent risk factor for multiple trauma complicated with PICS(OR=1.046,P<0.05),and CD4+/CD8+ratio is a protective factor(OR=0.486,P<0.05).7.ROC curve analysis:Age(intercept value:40.5,sensitivity:0.864,specificity:0.471,AUC:0.689),CD4+/CD8+ratio(intercept value:0.965,sensitivity:0.455,specificity:0.849,AUC:0.653)and the combination of age and CD4+/CD8+ratio(sensitivity:0.705,specificity:0.672,AUC:0.753)are valuable in predicting multiple trauma complicated with PICS,the prediction effect of age combined CD4+/CD8+ratio is better.Conclusions:1.PICS group showing more severe inflammatory responses,immunosuppression and metabolic disorders in early stage,with more complications and higher mortality.2.Age is an independent risk factor for multiple trauma complicated with PICS and CD4+/CD8+ratio is a protective factor.3.Age combined CD4+/CD8+ratio is a good predictor for PICS,the best prediction range for the multiple trauma complicated with PICS is age>40.5 years and CD4+/CD8+ratio<0.965.