Analysis Of Risk Factors And Prognosis Prediction Of Acute Traumatic Coagulopathy

Objective:Acute Traumatic Coagulopathy(ATC)has a high incidence in severe trauma and is difficult to prevent before hospital.Meanwhile,the disease progresses rapidly and leads to poor prognosis easily.In this study,we conducted a statistical analysis of the factors related to ATC patients to identify independent risk factors that may cause ATC in the early post-traumatic period.The aim was to efficiently identify high-risk groups of posttraumatic ATC and enhance attention and vigilance towards the disease’s development.Furthermore,this study aimed to explore the early risk factors associated with different clinical prognosis of patients with ATC and compare their predictive value on prognosis.The findings can serve as a reference for clinicians in the treatment of patients with ATC.Method:Clinical data from 1789 patients treated in the emergency room of Shizi Street Campus,the First Affiliated Hospital of Suzhou University from January 1,2020 to December 31,2021 were analyzed retrospectively.A total of 784 trauma patients were screened using the emergency triage record table.Data was collected from the trauma patients who met the inclusion and exclusion criteria for the study,resulting in a sample size of 377.①In accordance with the clinical diagnostic criteria of ATC,the study divided the participants into two groups:ATC group(92 cases)and non-ATC group(285 cases).The study employed statistical methods such as independent sample T test,chi-square test,and Mann-Whitney U test to analyze the differences in data between the two groups.Subsequently,univariate and multivariate logistic regression analysis was conducted to identify the early independent risk factors of ATC following trauma.②According to the clinical prognosis of patients with ATC within 28 days after admission,they were divided into death group(50 cases)and survival group(42 cases)to explore early risk factors that may affect different clinical outcomes of patients with ATC.The area under the Receiver Operating Characteristic(ROC)curve was used to determine the predictive ability of different indicators for the prognosis of patients with ATC,and an early risk prediction model for poor prognosis of patients with ATC was constructed.Results:(1)Compared with the non-ATC group,there were no significant differences in gender,injury type and most serious injury site(P>0.05).But,there were significant differences in age,ISS,GCS,TI.initial admission temperature,systolic blood pressure,diastolic blood pressure,heart rate and SI(P<0.05).Univariate and multivariate logistic analysis indicated that age≥60 years old.ISS≥16.TI≥15.and initial admission temperature≤36.5℃ were independent early risk factors for ATC in trauma patients.(2)There were no significant differences in gender,injury type,systolic blood pressure,diastolic blood pressure,prothrombin time,activated partial thrombin time.thrombin time,white blood cell count and glucose between the death group and the survival group of patients with ATC(P>0.05).There were significant differences in age,craniocerebral trauma.ISS,GCS,TI.temperature.heart rate.SI,international normalized ratio,fibrinogen,hemoglobin,platelet and albumin(P<0.05).Univariate and multivariate logistic analysis indicated that age≥ 65 years old,ISS≥20,craniocerebral trauma,platelet count≤100*10^9/L,hemoglobin≤104g/L were independent risk factors for death of patients with ATC after trauma.(3)The area under ROC curve of age.ISS,craniocerebral trauma.platelet count and hemoglobin were 0.881.0.756,0.654.0.902 and 0.729,respectively.The clinical early prediction ability of the five combined indexes on death of patients with ATC was analyzed ulteriorly,and the area under ROC curve was 0.990.Therefore,the early prediction model of ATC mortality risk was established as Logit(P)=-9.827+0.238*age+0.383*ISS+3.658*craniocerebral trauma-0.042*platelet count-0.097*hemoglobin.Hosmer-Lemeshow test model had a good fit with the observed values(χ2=3.724.P=0.881).Conclusion:(1)Age≥60 years old,ISS≥16.TI≥15,and initial admission temperature≤36.5℃ were independent early risk factors for ATC in trauma patients.(2)Age≥65 years old,ISS≥20,craniocerebral trauma,platelet count≤100*10^9/L,hemoglobin≤104g/L were independent risk factors for death of patients with ATC after trauma.(3)The area under ROC curve of age,ISS,craniocerebral trauma,platelet c ount,and hemoglobin was 0.990 combined in early prediction of death risk in p atients with ATC.The prediction model was simple with high discrimination and calibration.In the meantime,it had good efficacy in predicting prognosis of pat ients with ATC early in emergency work.