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

• Published in: Acute and critical care Vol. 32; no. 3; pp. 240 - 246
• Main Authors: Jang, Ha Nee, Park, Hyun Oh, Yang, Tae Won, Yang, Jun Ho, Kim, Sung Hwan, Moon, Seong Ho, Byun, Joung Hun, Lee, Chung Eun, Kim, Jong Woo, Kang, Dong Hun, Baek, Kyeong Hee
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society of Critical Care Medicine 01.08.2017; 대한중환자의학회
• Subjects: acidosis; hemoglobin; injuries; international normalized ratio; mortality; Original; 마취과학; mortality; injuries; international normalized ratio; acidosis; hemoglobin
• ISSN: 2383-4870; 2383-4889; 2586-6052; 2383-4889; 2586-6060
• DOI: 10.4266/kjccm.2017.00360

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. 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. 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%). 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.