Construction and verification of prediction model of traumatic hemorrhagic shock complicated by acute hepatic insufficiency

Yang Yucun; Zhao Jie; Li Shu; Fu Chun; Wang Zhenzhou; Xue Haiyan; Liu Xiaoxia; Zhao Xiujuan; Zhu Fengxue

doi:10.3969/j.issn.1002-1949.2024.10.002

Abstract：Objective To explore the risk factors of traumatic hemorrhagic shock complicated by acute hepatic insufficiency and to construct a prediction model for verification.Methods This study retrospectively studied 417 patients with traumatic hemorrhagic shock from January 2013 to May 2023.Various clinical indicators of patients during hospitalization were recorded,and the patients were divided into the acute hepatic insufficiency group(n=125)and the non-acute hepatic insufficiency group(n=292)according to whether acute hepatic insufficiency occurred within 3 d after traumatic hemorrhagic shock.Risk factors for acute hepatic insufficiency were identified by the Logistic regression model,then a nomogram prediction model was constructed and its performance was verified with internal data.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic effectiveness of the nomogram prediction model,and the clinical applicability of this model was evaluated by clinical decision curve analysis(DC A).Results The incidence of acute hepatic insufficiency after traumatic hemorrhagic shock was 30.0％.The Logistic regression model found that independent risk factors for acute hepatic insufficiency in the patients with traumatic hemorrhagic shock included pelvic bleeding(OR=2.311,95％CI 1.109-4.814,P=0.025),abdominal bleeding(OR=2.529,95％CI 1.104-5.794,P=0.028),fast heart rate(OR=1.020,95％CI 1.006-1.035,P=0.005),prolonged prothrombin time(OR=1.112,95％CI 1.003-1.233,P=0.044)and acute myocardial injury(OR=2.002,95％CI 1.113-3.600,P=0.020).The above independent risk factors were used to build a nomogram prediction model,and the area under ROC curve(AUC)of nomogram prediction model for predicting acute hepatic insufficiency were 0.840 with 95％CI 0.794-0.886,suggesting that the model had good discrimination.The Hosmer-Lemeshow goodness-of-fit test showed a good calibration with P＞0.05.At the same time,DC A showed that the nomogram prediction model had good clinical applicability.Conclusions The incidence of acute hepatic insufficiency is high in the patients with traumatic hemorrhagic shock.The nomogram prediction model based on pelvic bleeding,abdominal bleeding,heart rate,prothrombin time and acute myocardial injury has good clinical significance for the risk prediction of acute hepatic insufficiency in the patients with traumatic hemorrhagic shock.Early and timely monitoring and management of these indicators is conducive to early identification and treatment of traumatic hemorrhagic shock combined with acute hepatic insufficiency.