Albumin and hemoglobin to albumin ratio in evaluating the prognosis of patients with trau-matic hemorrhagic shock
Objective To investigate the predictive value of albumin(ALB)and hemoglobin to albumin ratio(HB/ALB)on the prognosis of patients with traumatic hemorrhagic shock(THS).Methods Data of 90 THS patients by green channel of the First Affiliated Hospital of Nanjing Medical University from Jan.2020 to Dec.2021 were retrospectively analyzed.Based on the 7-day outcome,patients were classified into survival group(n=76)and death group(n=14).Demographics,prehospital time,Glasgow coma scale/score(GCS),vital signs,ISS,first labo-ratory results on admission,fluid and blood transfusion within 24 h of admission,and secondary outcomes(incidence of multiple organ failure(MOF),use of mechanical ventilation,admission to ICU,etc.)were compared between the two groups.The area under the receiver operating characteristic curve was used to determine the cut-off value for each significant predictor of 7-day mortality,and univariate and multivariate logistic regression analyses were further adopted to explore the risk predictors.The Kaplan-Meier survival curves were drawn according to the cut-off of HB/ALB,and the relationship between HB/ALB and each secondary outcome was evaluated.Results Among the 90 THS patients,62 were male and 28 were female,with a mean age of 46.9 years.At 7 days,14 patients(15.6％)died and enrolled in the death group.Comparison between the 7-day death group and the survival group showed sig-nificant differences in terms of age(years,56.8±16.6 vs.45.0±18.3),GCS(12 vs.15),ISS(29 vs.19),urea nitrogen(mmol/L,8.0±2.6 vs.5.6±2.0),creatinine(mol/L,100.8 vs.61.3),ALB(g/L,23.2±4.0 vs.30.2±6.6),prothrombin time(s,15.7 vs.13.6),and activated partial thromboplastin time(s,34.9 vs.28.3).Multi-variate logistic regression revealed that ALB ≤ 28.1 g/L(OR=112.791,95％CI:1.663-7647.721,P=0.028)and GCS≤ 13(OR=18.293,95％CI:1.037-322.82,P=0.047)were independent risk factors for 7-day mortality of THS patients.The Kaplan-Meier 7-day survival curve showed that HB/ALB＞3.3 was associated with a much higher 7-day mortality(x2=9.096,P=0.003),together with higher incidences of MOF,mechanical ventilation,and admis-sion to ICU.Conclusion Early ALB level ≤28.1 g/L indicates that patients with THS may have a poor prognosis.HB/ALB＞3.3 indicates a higher risk of concomitant MOF,use of mechanical ventilation,and ICU admission.Dy-namic monitoring of ALB and HB/ALB is meaningful for assessing and guiding the resuscitation.
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