|
|
|
|
|
| Predictive value of the Reverse Shock Index Multiplied by Glasgow Coma Scale Score (rSIG) and lactic acid in the evaluation of prognosis in patients with trauma |
| Li Peng-fei, Yang Zhi-zhou, Sun Zhao-rui, Nie Shi-nan |
| Department of Emergency Medicine, General Hospital of Eastern Theater Command, Nanjing 210002, China |
|
|
|
|
Abstract Objective To explore the value of the Reverse Shock Index Multiplied by Glasgow Coma Scale Score (rSIG) and lactic acid in the evaluation of prognosis in trauma patients, and to provide clinicians with the basis for medical decision-making and treatment guidance. Methods The clinical data of 1284 trauma patients admitted to our hospital from January 2016 to January 2018 were collected. According to treatment outcome and rSIG value, the cases were divided into survival group and death group, rSIG ≤14.8 group and rSIG>14.8 group retrospectively, and the statistical significance of the indicators of vital signs, lactic acid, intensive care days, mortality, emergency treatment, blood transfusion, and patient′s whereabouts between groups were compared, and the relationship between rSIG and lactic acid was compared .The relationship between the above indexes and prognosis was analyzed. Results The rSIG and hospitalization days were significantly greater in the survival group than those in the death group, the blood lactate level was significantly lower than that in the death group ［(23.2±8.3) vs. (11.3±9.4), 13.0 (8.0, 19.0) vs. 4.0 (2.0,18.8), 1.5 (1.0,2.5)mmol/L vs. 4.5 (2.5,7.1) mmol/L, P<0.01］. Blood lactate level, intensive care days, 28 d-mortality (%) in patients with rSIG≤14.8 were significantly greater than those in the rSIG>14.8 group ［2.6(1.5,4.3) mmol/L vs. 1.5 (0.9,2.3) mmol/L, 11.0 (6.5,19.0) vs. 6.0 (2.3,10.0), 12.9 vs. 0.8, P<0.01］; rSIG was negatively correlated with lactate level (r=-0.347, P<0.01). The ability of rSIG combined with initial blood lactate value to judge patient 28-mortality is not superior to the predictive power of these two indicators alone for the prognosis of trauma patients (Z=1.45, Z=1.75, P＞0.05). Conclusion rSIG and lactic acid have good predictive value for the severity and prognosis of trauma patients, and have certain guiding significance in clinical practice.
|
|
|
|
Corresponding Authors:
Nie Shi-nan, E-mail: shn_nie@sina.com
|
|
|
|
| ［1］Kimura A, Tanaka N. Reverse shock index multiplied by Glasgow Coma Scale score (rSIG) is a simple measure with high discriminant ability for mortality risk in trauma patients: an analysis of the Japan Trauma Data Bank［J］. Crit Care, 2018, 22(1): 87.
［2］Wu SC, Rau CS, Kuo SCH, et al. The Reverse Shock Index Multiplied by Glasgow Coma Scale Score (rSIG) and Prediction of Mortality Outcome in Adult Trauma Patients: A Cross-Sectional Analysis Based on Registered Trauma Data［J］. Int J Environ Res Public Health, 2018, 15(11). pii: E2346.
［3］Rossaint R, Bouillon B, Cerny V, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition［J］. Crit Care, 2016, 20: 100.
［4］刘双庆，赵晓东. 《NICE严重创伤的评估和初始管理指南》解读［J］. 中国急救医学， 2016， 36(7): 577-580.
［5］陈鑫，李亮，杨志洲，等. D-二聚体联合损伤严重度评分对创伤患者预后的预测价值［J］. 中华急诊医学杂志， 2018， 27(5): 486-491.
［6］Kimura A, Chadbunchachai W, Nakahara S. Modification of the Trauma and Injury Severity Score (TRISS) method provides better survival prediction in Asian blunt trauma victims［J］. World J Surg, 2012,36(4): 813-818.
［7］Kimura A, Nakahara S, Chadbunchachai W. The development of simple survival prediction models for blunt trauma victims treated at Asian emergency centers［J］. Scand J Trauma Resusc Emerg Med, 2012, 20: 9.
［8］Cannon CM, Braxton CC, Kling-Smith M, et al. Utility of the shock index in predicting mortality in traumatically injured patients［J］. J Trauma, 2009, 67(6): 1426-1430.
［9］李末寒，刘一韡，陆士奇. 休克指数在急诊医学研究中的最新进展［J］. 中国急救医学， 2018， 38(3): 240-245.
［10］Gutierrez G, Reines HD, Wulf-Gutierrez ME. Clinical review: hemorrhagic shock［J］. Crit Care, 2004, 8(5): 373-381.
［11］Rady MY, Nightingale P, Little RA, et al. Shock index: a re-evaluation in acute circulatory failure［J］. Resuscitation, 1992, 23(3): 227-234.
［12］Heffner AC, Swords DS, Nussbaum ML, et al. Predictors of the complication of postintubation hypotension during emergency airway management［J］. J Crit Care, 2012, 27(6): 587-593.
［13］Mitra B, Fitzgerald M, Chan J. The utility of a shock index≥1 as an indication for pre-hospital oxygen carrier administration in major trauma［J］. Injury, 2014, 45(1): 61-65.
［14］Talmor D, Jones AE, Rubinson L, et al. Simple triage scoring system predicting death and the need for critical care resources for use during epidemics［J］. Crit Care Med, 2007, 35(5): 1251-1256.
［15］McNab A, Burns B, Bhullar I, et al. A prehospital shock index for trauma correlates with measures of hospital resource use and mortality［J］. Surgery, 2012, 152(3): 473-476.
［16］Mutschler M, Nienaber U, Münzberg M, et al. The Shock Index revisited - a fast guide to transfusion requirement A retrospective analysis on 21,853 patients derived from the TraumaRegister DGU［J］. Crit Care, 2013, 17(4): R172.
［17］李国民，万健，袁冬，等. 乌司他丁对重型创伤性脑损伤患者颈内静脉血乳酸的影响［J］. 中华危重症医学杂志（电子版）， 2012， 5(2): 95-99.
［18］叶阳，周瑞卿，胡志强. 急性呼吸窘迫综合征患者血乳酸和红细胞分布宽度与病情严重程度的相关性分析［J］. 中国急救医学， 2018， 38(6): 481-484.
［19］Bakker J, Jansen TC. Don′t take vitals, take a lactate［J］. Intens Care Med, 2007, 33(11): 1863-1865.
［20］Vandromme MJ, Griffin RL, Weinberg JA, et al. Lactate is a better predictor than systolic blood pressure for determining blood requirement and mortality: could prehospital measures improve trauma triage［J］. J Am Coll Surg, 2010, 210(5): 861-867, 867-869.
［21］Dezman ZD, Comer AC, Smith GS, et al. Failure to clear elevated lactate predicts 24-hour mortality in trauma patients［J］. J Trauma Acute Care Surg, 2015, 79(4): 580-585.
［22］Odom SR, Howell MD, Silva GS, et al. Lactate clearance as a predictor of mortality in trauma patients［J］. J Trauma Acute Care Surg, 2013, 74(4): 999-1004.
［23］Cusack R J, Rhodes A, Lochhead P, et al. The strong ion gap does not have prognostic value in critically ill patients in a mixed medical/surgical adult ICU［J］. Intens Care Med, 2002, 28(7): 864-869. |
|
|
|
Address: 1 North 2nd Street,
Zhongguancun, 
