The Predictive Value Of Pcv-aCO2/Da-vO₂ On The 28-day Survival Rate Of Multiple Trauma Patients With Hemorrhagic Shock

Objective:Our aim is to explore the predictive value of initial metabolic rates of oxygen（Pcv-aCO₂/Da-vO₂,Pcv-aCO₂,Lac and ScvO₂）for the 28-day survival rate of multiple trauma patients with hemorrhagic shock by analyzing the difference of these rates,to provide the basis for further clinical application.Methods:A prospective and observational study method be used.The Fifth Affiliated Hospital of Zunyi Medical University,Zhuhai and Tungwah Hospital of Sun Yat-sen University were selected as subjects.Patients with multiple trauma and hemorrhagic shock admitted to the above two sub-centers from June 2019 to December 2020 were selected as the research subjects.They signed informed consent,exchanged contact information,filled out case report forms,recorded demographic information,and underwent central venous and arterial puncture catheterization.And,they were treated based on guideline and clinical standards for this disease,given routine life support and positive treatment of primary diseases.General information such as gender,age,Main injury site and time of injury,etc.was collected.Arterial and central venous blood samples at T0 were collected for blood gas analysis,and the Acute Physiology and Chronic Health Evaluation II（APACHE Ⅱ）and metabolic indicators of oxygen were also collected.Relevant indicators were registered,summarized,and statistically analyzed.According to the outcome of 28 days in hospital,the patients were divided into death group and survival group.The oxygen metabolism levels of the two groups were compared,Spearman method was used to analyze the correlation between oxygen metabolism index and APACHEⅡscore.Multivariate logistic regression analysis was performed to analyze the influence of oxygen metabolism indicators on the prognosis of multiple trauma with hemorrhagic shock.The receiver operating characteristic curve（ROC）was used to analyze the predictive value of each indicator for the 28-day survival rate of multiple trauma patients with hemorrhagic shock,and the combined test was used to analyze the predictive value of the combined indicators for patients.Results:1.After screening,176 multiple trauma patients with hemorrhagic shock from the Fifth Affiliated Hospital of Zunyi Medical University,Zhuhai and Tungwah Hospital of Sun Yat-sen University were selected as subjects,and they were divided into survival group（n=118）or death group（n=58）according to 28-day survival condition.There was no statistical difference between the two groups in gender,age,Main injury site and time of injury（P>0.05）.The APACHE Ⅱ score of the death group was higher than that of the survival group,and there was a statistical difference between the two groups（P<0.05）.The Pcv-aCO₂/Da-vO₂and Lac in the death group were higher than those in the survival group,and there was a statistical difference between the two groups（P<0.05）.There was no significant difference between the two groups in ScvO₂and Pcv-aCO₂（P>0.05）.2.There was a moderately positive correlation between Pcv-aCO₂/Da-vO₂and APACHE Ⅱ score（r=0.508,P<0.05）,and there was a moderately positive correlation between Lac and APACHE Ⅱ score（r=0.421,P<0.05）,a low positive correlation between Pcv-aCO₂and APACHE Ⅱ score（r=0.355,P<0.05）,and no correlation between ScvO₂and APACHE Ⅱ score（r=0.225,P<0.05）.3.The Pcv-aCO₂/Da-vO₂ratio and APACHE Ⅱ score are independent risk factors for poor prognosis（OR>1）,and they are significantly positive correlated with poor prognosis（P<0.05）.Lac is not an independent factor affecting poor prognosis（P>0.05）.4.The area under the ROC curve of the ratio of Pcv-aCO₂/Da-vO₂is0.775（95%CI 0.699～0.852）（P<0.05）,which is better than other predictors.5.The Pcv-aCO₂/Da-vO₂ratio is 1.53,the sensitivity and specificity are 82.80%and 69.90%,respectively,and the Youden index is 0.50,which is better than other predictive indicators.6.The Pcv-aCO₂/Da-vO₂ratio and the APACHE Ⅱ score are 1.53 and 23.50 respectively as the best critical values,the sensitivity rate of the serial test is 34.28%,the specificity rate is97.50%,and the Youden index is 0.32;the sensitivity of the parallel test is 89.56%,the specificity is 61.64%,and the Youden index is 0.51.Conclusion:1.The Pcv-aCO₂/Da-vO₂ratio is an good indicator for predicting the 28-day survival rate of multiple trauma patients with hemorrhagic shock.2.The Pcv-aCO₂/Da-vO₂and APACHE Ⅱ are 1.53 and 23.50 as the critical values,Parallel test has higher predictive value for the 28-day survival rate of patients with multiple trauma and hemorrhagic shock than serial test.