RTS评分联合BAR预测急诊创伤绿色通道患者预后的回顾性研究
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南京医科大学第一附属医院急诊科

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急救与创伤研究教育部重点实验室(海南医学院)开放课题基金(Grant. KLET-2021**)


A retrospective study of the RTS combined with BAR to predict prognosis of patients in Emergency Trauma Green Channel
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    摘要:

    目的 对比血浆白蛋白(serum albumin,sALB)、血尿素氮(blood urea nitrogen,BUN)与血尿素氮/血浆白蛋白(blood urea nitrogen/serum albumin,BAR)对创伤绿色通道患者28天死亡的预测价值,并联合修正创伤评分(the Revised Trauma Score,RTS)构建预测28天死亡的模型。 方法 回顾性分析2020年01月至2020年12月创伤绿色通道患者的临床资料,比较28天生存组与死亡组之间的人口统计学差异、既往史、RTS评分、创伤严重程度评分、实验室结果,并用受试者工作特征(the receiver operating characteristic,ROC)曲线确定sALB、BUN和BAR的临界值,通过DeLong非参数方法对比sALB、BUN与BAR预测28天死亡的ROC曲线下面积(the area under the ROC curve,AUROC)。将RTS评分分别联合上述三个指标构建预测模型,用Hosmer-Lemeshow检验法评价模型效果,并对比模型的预测效果。 结果 最终419例患者被纳入,年龄54.3±16.4岁,男性309例(73.7%),院前时间4.0(2.0-6.0)小时,28天死亡率7.6%(32/419)。ROC曲线示sALB≤29.5g/L、BUN>6.97mmol/L、BAR>7.39mg/g分别是预测急诊创伤绿色通道患者28天死亡的临界值,且BRA的预测效果优于sALB与BUN。RTS分别联合sALB、BUN与BAR构建预测模型RTS-A(RTS+sALB)、RTS-B(RTS+BUN)与RTS-BAR(RTS+BAR),预测效果均优于RTS评分,其中RTS-BAR的AUROC最大,但RTS-BAR与RTS-A、RTS-A与RTS-B的AUROC之间不存在统计学差异。 结论 BAR预测创伤绿色通道患者28天死亡的能力优于sALB与BUN,BAR>7.39mg/g提示预后不佳。RTS评分联合BAR预测创伤绿色通道患者的预后也存在较好的价值。

    Abstract:

    Objective To compare the predictive value of serum albumin (sALB), blood urea nitrogen (BUN) and blood urea nitrogen/plasma albumin (BAR) for 28-day mortality in patients in Trauma Green Channel, and to construct a model for predicting 28-day mortality by combining the Revised Trauma Score (RTS). Methods The clinical data of patients in Trauma Green Channel from January 2020 to December 2020 were retrospectively analyzed to compare the demographic differences, past history, the RTS, the Injury Severity Score, and laboratory results between 28-day survival and death groups. The cut-off values of sALB, BUN and BAR were determined by receiver operating characteristic (ROC) curve, and the area under the ROC curve (AUROC) of sALB, BUN and BAR in predicting 28-day mortality was compared by DeLong non-parametric method. The RTS was combined with each of the above three indicators to construct a prediction model respectively, and the Hosmer-Lemeshow test was used to evaluate the model effect and compare the prediction effect of the models. Results Finally, 419 patients were included, aged 54.3±16.4 years, 309 (73.7%) men, prehospital time 4.0 (2.0-6.0) hours, and 28-day mortality 7.6% (32/419). The ROC curve showed that sALB ≤ 29.5g/L, BUN> 6.97mmol/L and BAR> 7.39mg/g were the cut-off values to predict the 28-day mortality of patients in Trauma Green Channel, and the predictive effect of BRA was better than that of sALB and BUN. RTS-A (RTS+sALB), RTS-B (RTS+BUN) and RTS-BAR (RTS+BAR) were used to construct the predictive models of the RTS combined with sALB, BUN and BAR, respectively. The predictive effect of these three models was better than that of the RTS, and AUROC of RTS-BAR was the largest, but there was no statistical difference between the AUROC of RTS-BAR and RTS-A, and between the AUROC of RTS-A and RTS-B. Conclusion BAR was superior to sALB and BUN in predicting 28-day mortality of patients in Trauma Green Channel, and patients with BAR> 7.39 mg/g indicated poor prognosis. The RTS combined with BAR also has a good value in predicting the prognosis of patients in Trauma Green Channel.

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  • 收稿日期:2023-04-30
  • 最后修改日期:2023-06-28
  • 录用日期:2023-10-25
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