Construction and verification of a risk prediction model for the prognosis of patients with emergency trauma complicated by trauma-induced coagulopathy

Fang Jie; Huang Jian; Zheng Hui

doi:10.3969/j.issn.1002-1949.2024.10.005

Abstract：Objective To explore the prognostic factors of patients with emergency trauma complicated by trauma-induced coagulopathy(TIC)and to construct a risk prediction model.Methods This study was a retrospective study,the clinical data were collected from 246 patients with emergency trauma complicated by TIC admitted to Hangzhou Ninth People's Hospital from January 2021 to December 2023.According to a 7∶3 ratio,the patients were divided into a training set(n=172)and a validation set(n=74),and the clinical data of patients in the two groups were compared to clarify the comparability.Patients in the training set were divided into a death group(n=60)and a survival group(n=112)based on their survival status within 28 d of TIC diagnosis.The clinical data of the two groups were compared,and the variables with statistically significant differences were analyzed by Cox regression analysis to obtain the possible influencing factors of the prognosis in the patients with emergency trauma complicated by TIC.Based on the results of Cox regression analysis,a risk prediction model for the prognosis of patients with emergency trauma complicated by TIC was constructed,and the prediction efficiency of the model was verified internally.Results The difference in clinical data between the training set and the validation set was not statistically significant(P＞0.05).The proportion of patients in the death group with injury severity score(ISS)score ≥ 25 points at admission(all P＜0.05),the hypothermia at the diagnosis of TIC,and without tranexamic acid treatment was higher than that in the survival group.Peripheral blood platelet and plasma fibrinogen levels were lower than those in the survival group,while serum C-reactive protein and plasma lactate levels were higher than those in the survival group(all P＜0.05).The Cox regression analysis results showed that ISS score≥25 points at admission,the hypothermia at the diagnosis of TIC,low plasma fibrinogen levels and high plasma lactate levels may all be independent risk factors for the mortality in the patients with emergency trauma complicated by TIC(P＜0.05).Decision curve found that the risk prediction model based on the prognostic factors of patients with emergency trauma complicated by TIC had a risk threshold in the range of 0.00-1.00,and the clinical net benefit rate of the model was always greater than 0,with a maximum net benefit rate of 0.332.A nomogram was drawn to visualize the risk prediction model.The results showed that the C-index of the model predicting the mortality of patients with emergency trauma complicated by TIC was 0.820(95％CI 0.776-0.864),and the model had good discrimination.The calibration curve approached the ideal curve,indicating good consistency between the predicted probability of the model and the actual probability of occurrence.The internal verification results showed that the area under the curve of the risk prediction model for predicting the mortality in the patients with emergency trauma complicated by TIC was 0.958(95％CI 0.918-0.999),and the established prediction model also had good predictive performance in the validation set.Conclusions The ISS score at admission,the hypothermia at diagnosis of TIC,plasma fibrinogen and plasma lactate may all be influencing factors on the prognosis(survival status)of patients with emergency trauma complicated by TIC.The risk prediction model constructed based on those factors has good predictive value for the mortality risk of the patients.