Analysis of clinical risk factors associated with the prognosis of severe multiple-trauma patients with acute lung injury.
BACKGROUND
Several clinical risk factors have been reported to be associated with the prognosis of acute lung injury (ALI). However, these studies have included a general trauma patient population, without singling out the severely injured multiple-trauma patient population.


OBJECTIVE
To identify the potential risk factors that could affect the prognosis of ALI in multiple-trauma patients and investigate the prognostic effects of certain risk factors among different patient subpopulations.


METHODS
In this retrospective cohort study, severely injured multiple-trauma patients with early onset of ALI from several trauma centers were studied. Potential risk factors affecting the prognosis of ALI were examined by univariate and multivariate logistic analyses.


RESULTS
There were 609 multiple-trauma patients with ALI admitted to the emergency department and emergency intensive care unit during the study period. The nine risk factors that affected prognosis, as indicated by the unadjusted odds ratios with 95% confidence intervals, were the APACHE II (Acute Physiology and Chronic Health Evaluation II) score, duration of trauma, age, gastrointestinal hemorrhage, pulmonary contusion, disseminated intravascular coagulation (DIC), multiple blood transfusions in 6 h, Injury Severity Score (ISS), and aspiration of gastric contents. Specific risk factors also affected different patient subpopulations in different ways.


CONCLUSIONS
Patients older than 65 years and with multiple (> 10 units) blood transfusions in the early stage after multiple trauma were found to be independent risk factors associated with deterioration of ALI. The other factors studied, including pulmonary contusion, APACHE II score ≥ 20, ISS ≥ 16, gastrointestinal hemorrhage, and aspiration of gastric contents, may predict the unfavorable prognosis of ALI in the early stage of trauma, with their effects attenuating in the later stage. Duration of trauma ≥ 1 h and the presence of DIC may also indicate unfavorable prognosis during the entire treatment period.
Wu
Junsong
J
Trauma Centre of Emergency Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
Sheng
Lei
L
Wang
Shenhua
S
Li
Qiang
Q
Zhang
Mao
M
Xu
Shaowen
S
Gan
Jianxin
J
D018806:APACHE; D055371:Acute Lung Injury / Q000401:mortality*; D000328:Adult; D000367:Age Factors; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D003288:Contusions / Q000453:epidemiology; D004211:Disseminated Intravascular Coagulation / Q000453:epidemiology; D004636:Emergency Service, Hospital; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D055370:Lung Injury / Q000453:epidemiology; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality*; D011379:Prognosis; D063466:Respiratory Aspiration of Gastric Contents / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014193:Trauma Centers