Construction of a nomogram model based on ISS and coagulation-related indicators to predict intra-abdominal rebleeding after thoracotomy in emergency patients with thoracoabdominal injuries

WU Dinghua; YAO Tingting; ZHENG Yan; ZHOU Ting; YANG Ya'nan

doi:10.3969/j.issn.1674-3806.2025.10.08

Abstract：Objective To construct a nomogram model based on Injury Severity Scores(ISS)and coagulation-related indicators to predict intra-abdominal rebleeding after thoracotomy in emergency patients with thoracoabdominal injuries,and to analyze its clinical application value.Methods A retrospective analysis was conducted on the clinical data of 205 emergency patients with thoracoabdominal injuries who were admitted to Honghui Hospital Affiliated to Xi'an Jiaotong University from September 2021 to June 2023.All the patients were treated with thoracotomy.According to the occurrence of intra-abdominal rebleeding after surgery,the patients were divided into rebleeding group(n=73)and non-rebleeding group(n=132).The data such as preoperative platelet-to-lymphocyte ratio(PLR),platelet alpha granule membrane protein-140(GMP-140),ISS,prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinogen(FIB)were compared between the two groups.Multivariate logistic regression was used to analyze the factors influencing intra-abdominal rebleeding after thoracotomy in the emergency patients with thoracoabdominal injuries.Based on the results of multivariate logistic regression analysis,a nomogram model was constructed to predict intra-abdominal rebleeding after thoracotomy in the emergency patients with thoracoabdominal injuries.The predictive efficacy and application value of the nomogram model were analyzed by using receiver operating characteristic(ROC)curve,calibration curve and decision curve.Results The levels of ISS,PT,APTT,PLR and GMP-140 in the rebleeding group were higher than those in the non-rebleeding group,and the level of FIB in the rebleeding group was lower than that in the non-rebleeding group,with statistically significant differences between the two groups(P＜0.05).The results of multivariate logistic regression analysis showed that higher levels of ISS,PT,APTT,FIB,PLR and GMP-140 were independent risk factors for intra-abdominal rebleeding after thoracotomy in the emergency patients with thoracoabdominal injuries(P＜0.05).A nomogram model for predicting intra-abdominal rebleeding after thoracotomy in the emergency patients with thoracoabdominal injuries was constructed based on ISS,PT,APTT,FIB,PLR and GMP-140 indicators.The results of ROC curve analysis showed that the nomogram model had good predictive efficacy[AUC(95%CI)=0.913(0.874-0.952)],with a sensitivity of 86.30%and a specificity of 89.39%.The results of calibration curve analysis showed that the actual curve was basically in line with the calibration curve,suggesting that the nomogram model had good predictive efficacy.The results of decision curve analysis showed that within the threshold probability ranging from 0.10 to 0.81,the clinical utility of the nomogram was good.Conclusion The nomogram model constructed in this study has good clinical application value for predicting intra-abdominal rebleeding after thoracotomy in emergency patients with thoracoabdominal injuries.It is helpful for clinical screening of high-risk patients,providing guidance for early intervention,and reducing the rate of secondary surgery and mortality.