摘要
目的:探讨血清钙水平与创伤性凝血病（TIC）患者预后的相关性。方法:回顾性分析2015年1月至2023年1月因TIC入住嘉兴市第一医院ICU的142例患者的临床资料，按入ICU后28 d的预后分为存活组（80例）和死亡组（62例）。对比两组患者的基本资料、入ICU后24 h内的实验室检查指标及血液消耗量评估评分。采用多因素logistic回归分析TIC患者的预后危险因素，并绘制受试者工作特征（ROC）曲线分析血清钙对TIC患者发生死亡危险的诊断价值。同时，采用限制性立方样条图（RCS）评价入ICU后首次血清钙水平与TIC患者死亡风险之间的线性关系。结果:与存活组患者比较，死亡组患者低纤维蛋白原[65.0%（52/80）vs. 88.7%（55/62），χ2 = 3.240，P<0.001]、高乳酸血症[65.0%（52/80）vs. 88.7%（55/62），χ2 = 3.240，P<0.001]、低钙血症[73.8%（59/80）vs. 96.8%（60/62），χ2 = 3.223，P<0.001]占比均较高，血小板计数[118（84，148）× 109/L vs. 94（50，116）× 109/L，Z = 3.447，P<0.001]及白蛋白水平[（28 ± 6）g/L vs. （23 ± 8）g/L，t = 3.732，P<0.001]均显著降低，血清氯显著升高[113（110，116）mmol/L vs. 115（111，118）mmol/L，Z = 2.350，P = 0.019]。多因素logistic回归分析显示，低钙血症[比值比（OR）= 5.019，95%置信区间（CI）（1.279，19.690），P = 0.021]以及高乳酸血症[OR = 3.970，95%CI（1.353，11.075），P = 0.012]是TIC患者死亡的独立危险因素。ROC曲线显示，血清钙的曲线下面积为0.734[95%CI（0.652，0.816），P<0.001]，最佳截断值为1.950 mmol/L。RCS发现血清钙与TIC患者预后之间呈线性关系（P = 0.023），且TIC患者入院后血清钙在1.603 ~ 2.130 mmol/L范围内死亡风险随着血钙浓度的升高而降低。结论:低钙血症是TIC患者死亡的独立危险因素，尤其是当血清钙低于1.950 mmol/L时在预测TIC患者死亡风险方面具有重要价值。
Abstract
Objective:To investigate the prognostic value of serum calcium levels in patients with trauma-induced coagulopathy (TIC).Methods:A retrospective analysis was conducted on the clinical data of 142 patients with TIC who were admitted to the ICU of the First Hospital of Jiaxing between January 2015 and January 2023. According to the prognosis of 28 days after ICU admission, patients were divided into a survival group (80 cases) and a death group (62 cases). The basic data, laboratory examination indexes within 24 h after admission to the ICU and assessment of blood consumption scores of the two groups were compared. Multivariate logistic regression was used to analyze the prognostic risk factors of TIC patients, and a receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic value of serum calcium in the risk of death in TIC patients. A restricted cubic spline (RCS) was used to evaluate the linear relationship between the first serum calcium level after admission to the ICU and the risk of death in TIC patients.Results:Compared with the survival group, the proportions of low fibrinogen [65.0% (52/80) vs. 88.7% (55/62), χ2 = 3.240, P < 0.001], hyperlactacidemia [65.0% (52/80) vs. 88.7% (55/62), χ2 = 3.240, P < 0.001] and hypocalcaemia [73.8% (59/80) vs. 96.8% (60/62), χ2 = 3.223, P < 0.001] and the serum chlorine level [113 (110, 116) mmol/L vs. 115 (111, 118) mmol/L, Z = 2.350, P = 0.019] were much higher, and the platelet count [118 (84, 148) × 109/L vs. 94 (50, 116) × 109/L, Z = 3.447, P < 0.001] and albumin level [(28 ± 6) g/L vs. (23 ± 8) g/L, t = 3.732, P < 0.001] were much lower in the death group. The multivariate logistic regression analysis indicated that hypocalcaemia [odds ratio (OR) = 5.019, 95% confidence interval (CI) (1.279, 19.690), P = 0.021] and hyperlactacidemia [OR = 3.970, 95%CI (1.353, 11.075), P = 0.012] were risk factors for death in patients with TIC. The ROC curve analysis revealed that the area under the curve for serum calcium was 0.734 [95%CI (0.652, 0.816), P < 0.001], and the best cut-off value was 1.950 mmol/L. The RCS showed that there was a linear relationship between serum calcium and prognosis of TIC patients (P = 0.023), and the risk of death decreased with the increase of serum calcium concentration in the range of 1.603 to 2.130 mmol/L after admission.Conclusion:Hypocalcaemia is an independent risk factor for death in TIC patients; especially when serum calcium is lower than 1.950 mmol/L, it has important value in predicting the risk of death.
基金项目
嘉兴市重症医学重点支撑学科建设项目(2023-ZC-003)
嘉兴市科技计划项目(2023AY31020)
嘉兴市急诊医学重点支撑学科建设项目(2023-ZC-004)
ICU镇静镇痛专项研究基金(Z-2017-24-2028-31)
嘉兴市公益类项目(2023AD11029)
万方数据