Korean J Crit Care Med.  2017 Aug;32(3):240-246. 10.4266/kjccm.2017.00360.

Biochemical Markers as Predictors of In-Hospital Mortality in Patients with Severe Trauma: A Retrospective Cohort Study

• Jang HN
• Park HO
• Yang TW
• Yang JH
• Kim SH
• Moon SH
• Byun JH
• Lee CE
• Kim JW
• Kang DH
• Baek KH

• KMID: 2391183
• DOI: http://doi.org/10.4266/kjccm.2017.00360

Abstract

BACKGROUND
Initial evaluation of injury severity in trauma patients is an important and challenging task. We aimed to assess whether easily measurable biochemical parameters (hemoglobin, pH, and prothrombin time/international normalized ratio [PT/INR]) can predict in-hospital mortality in patients with severe trauma.
METHODS
This retrospective study involved review of the medical records of 315 patients with severe trauma and an injury severity score >15 who were managed at Gyeongsang National University Hospital between January 2005 and December 2015. We extracted the following data: in-hospital mortality, injury severity score, and initial hemoglobin level, pH, and PT/INR. The predictive values of these variables were compared using receiver operation characteristic curves.
RESULTS
Of the 315 patients, 72 (22.9%) died. The in-hospital mortality rates of patients with hemoglobin levels <8.4 g/dl and ≥8.4 g/dl were 49.8% and 9.9%, respectively (P < 0.001). At a cutoff hemoglobin level of 8.4 g/dl, the sensitivity and specificity values for mortality were 81.9% and 86.4%, respectively. At a pH cutoff of 7.25, the sensitivity and specificity values for mortality were 66.7% and 77.8%, respectively; 66.7% of patients with a pH <7.25 died versus 22.2% with a pH ≥7.25 (P < 0.001). The in-hospital mortality rates for patients with PT/INR values ≥1.4 and <1.4 were 37.5% and 16%, respectively (P < 0.001; sensitivity, 37.5%; specificity, 84%).
CONCLUSIONS
Using the suggested cutoff values, hemoglobin level, pH, and PT/INR can simply and easily be used to predict in-hospital mortality in patients with severe trauma.

Keyword

acidosis; hemoglobin; injuries; international normalized ratio; mortality

MeSH Terms

Acidosis
Biomarkers*
Cohort Studies*
Hospital Mortality*
Humans
Hydrogen-Ion Concentration
Injury Severity Score
International Normalized Ratio
Medical Records
Mortality
Prothrombin
Retrospective Studies*
Sensitivity and Specificity
Biomarkers
Prothrombin

Figure

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  Figure 1. Outline of patient selection and exclusion. ISS: injury severity score.

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  Figure 2. Mechanism of injury.

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  Figure 3. Receiver operation characteristic curves for in-hospital mortality. AUC, area under the curve; Hb: hemoglobin; INR, international normalized ratio; ISS, injury severity score.

Reference

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